Columbia  WLnibzvmp 

in  tbtMt?  of  Beta  $orfe    \m  |o 

g>cfjool  of  Bental  anb  <^ral  burger? 


Reference  Htbrarp 


-\* 


^ 


MODERN    DENTAL  MATERIA  MEDICA, 
PHARMACOLOGY  AND  THERAPEUTICS 

BU.CKLEY 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 
Columbia  University  Libraries 


http://www.archive.org/details/moderndentalmateOObuck 


Modern  Dental  Materia  Medica, 
Pharmacology  and  Therapeutics 


INCLUDING  THE  PRACTICAL  APPLICATION 

OF  DRUGS  AND  REMEDIES  IN  THE 

TREATMENT  OF  DISEASE 


BY 

J.  P.  BUCKLEY,  Ph.  G„  D.  D.  S. 

PROFESSOR    AND    HEAD    OF    THE    DEPARTMENT    OF    MATERIA    MEDICA,    PHA  RM  ACOLOC,  V    AND 

THERAPEUTICS,    AND    FORMERLY    DIRECTOR    OF    THE    CHEMICAL    LABORATORIES, 

CHICAGO    COLLEGE   OF    DENTAL   SURGERY 


SECOND  EDITION 
FORTY-SIX  ILLUSTRATIONS 


PHILADELPHIA 

P.  BLAKISTON'S  SON  &  CO. 

1012  WALNUT   STREET 
1910 


Copyright,  1909,  by  P.  Blakiston's  Son  &  Co. 

Copyright,  1910,  by  P.  Blakiston's  Son  &  Co. 

Reprinted,  October,  1910. 


"  Authority  to  use  for  comment  the  Pharmacopoeia  of  the  United  States 
of  America,  Eighth  Decennial  Revision,  in  this  volume,  has  been  granted 
by  the  Board  of  Trustees  of  the  United  States  Pharmacopoeial  Conven- 
tion, which  Board  of  Trustees  is  in  no  way  responsible  for  the  accuracy 
of  any  translations  of  the  official  weights  and  measures  or  for  any 
statements  as  to  strength  of  official  preparations." 


Printed  by 

The  Maple  Press 

York,  Pa. 


TO 

THE    MEMORY    OF 

MY    MOTHER, 

WHOSE    ENCOURAGEMENT    IN    MY    BOYHOOD    DAYS 

SERVED    ME    SO    WELL, 

AND    TO 

MY    WIFE, 

FOR    St  ANY    WILLING    SACRIFICES    DURING    THE 

PAST    ELEVEN   YEARS, 

THIS    VOLUME    IS    FONDLY 

DEDICATED. 


PREFACE  TO  THE  SECOND  EDITION 


I  desire  to  take  this  opportunity  to  express  my  appreciation  ot 
the  hearty  reception  which  this  work  has  received  from  the  dental 
profession — the  entire  first  edition  having  been  exhausted  within  five 
months  from  the  date  of  publication.  This  is  not  only  gratifying, 
but  it  renders  unnecessary  any  great  amount  of  revision  in  this 
edition. 

However,  I  have  taken  advantage  of  this  opportunity  to  read 
the  text  thoroughly  and  have  made  such  changes  and  corrections  as 
were  required. 

J.  P.  Buckley. 

Chicago,  March,  1910. 


Ml 


PREFACE  TO  THE  FIRST  EDITION 


The  general  plan  of  this  book  is  the  outgrowth  of  many  years 
of  experience  as  a  dental  practitioner  and  teacher  of  Materia  Medica, 
Pharmacology  and  Therapeutics  in  dental  colleges.  During  these 
years,  the  author  has  realized  the  need  of  a  text-book  which  would 
meet  the  wants  of  teacher,  student  and  practitioner. 

The  book  is  intended  to  include  all  that  a  dentist  should  know 
about  drugs  and  remedies  and  their  practical  application  in  the  treat- 
ment of  disease. 

The  work  is  divided  into  two  parts.  The  first  is  devoted  to 
Materia  Medica  and  Pharmacology,  with  enough  Therapeutics  to 
indicate  clearly  the  uses  of  the  various  drugs  and  remedies;  and  an 
effort  has  been  made  to  include  herein  every  drug  or  remedy  which 
is  employed  in  Dental  Therapeutics,  except,  those  which  are  obsolete, 
untried  or  savor  of  the  " secret  formula"  variety.  To  accomplish 
this  end,  it  was,  of  course,  necessary  to  consult  freely  the  United  States 
Pharmacopeia,  and  other  standard  works  on  these  subjects. 

Drugs  marked  with  an  asterisk  (*)  means  that  the  drug  is  a 
member  of  the  group  under  consideration,  but  because  of  other  proper- 
ties which  the  agent  possesses,  it  has  been  elsewhere  considered. 
In  most  instances,  the  drug  is  discussed  under  the  group  in  which  it  is 
first  mentioned,  and  if  it  is  referred  to  subsequently  in  another  group, 
it  is  there  marked  with  an  asterisk.  For  example,  phenol  is  mentioned 
first  as  a  disinfectant  under  which  group  of  drugs  it  is  discussed.  Later 
it  is  mentioned  in  the  group  of  escharotics,  and  is  there  marked  with 
an  asterisk. 

In  this  part  of  the  book,  also,  is  included  Prescription  Writing  and 
its  associated  subjects. — Metrology,  Medical  Latin  and  Incompatibility, 
all  of  which  have  been  given  the  dignity  and  importance  they 
deserve  in  a  dental  course.  It  will  be  observed  that  no  prescriptions 
have  been  written  until  after  Prescription  Writing  has  been  discussed; 
after  which,  however,  no  formula  has  been  mentioned  without  a  cor- 
rectly written  prescription  for  the  same.  This  plan  was  followed  for 
the  benefit  of  teachers  and  students  in  dental  colleges.  Prescriptions, 
as  a  rule,  are  confusing,  though  enticing  to  beginners,  and  questions 
naturally  suggest  themselves  in  regard  to  the  various  signs  and  terms 
used.  For  the  teacher  to  attempt  to  explain  these  before  the  subject 
proper   had   been   studied  would   be  a  loss  of  time,  as  no  one  can 

ix 


X  PREFACE. 

write  a  prescription  intelligently  without  first  being  familiar  with 
drugs.  Therefore,  it  is  better,  in  the  author's  opinion,  to  avoid  even 
the  suggestion  of  questions  pertaining  to  prescriptions  at  this  time. 
By  thus  deferring  the  study  of  Prescription  Writing  to  about  the  close 
of  the  Junior  year,  an  excellent  opportunity  is  afforded  for  practice 
work  throughout  the  entire  Senior  year  when  Practical  Therapeutics 
is  taught.  By  this  means  only  can  students  become  good  prescription 
writers — a  faculty  not  developed  by  the  average  dentist. 

The  second  part  of  the  book  is  devoted  to  Practical  Dental  Thera- 
peutics. In  writing  it  the  author  wras  actuated  by  the  belief  that 
Dental  Therapeutics  is  of  sufficient  importance  to  occupy  a  place  in 
dentistry  by  itself.  It  is  to  be  hoped  that  this  subject  may  ultimately 
be  divorced  from  Operative  Dentistry,  to  which  it  has  long  been 
subordinated. 

No  attempt  has  been  made  to  describe  all  of  the  many  methods  of 
treatment,  nor  to  give  the  endless  formulas  suggested  in  the  various 
text-books  and  journals,  for  the  pathologic  conditions  mentioned  herein. 
To  do  so  would  lead  to  confusion,  as  well  as  make  the  book  unneces- 
sarily voluminous,  in  which  case  the  word  "practical"  in  connec- 
tion with  "therapeutics,"  as  used  here,  would  be  a  misnomer.  There- 
fore, in  most  instances,  only  the  methods  by  which  the  conditions  are 
treated  in  the  author's  own  practice  are  detailed.  These  methods,  of 
course,  are  not  wholly  original.  They  have  been  gleaned  from  clinical 
experience,  from  extensive  reading,  and  from  observation  and  associa- 
tion with  other  practitioners;  and  in  both  private  and  infirmary 
practice  they  have  given  good  results. 

The  prescriptions  for  remedies,  for  the  most  part,  are  original 
with  the  author,  and  have  been  worked  out  along  the  lines  of  practi- 
cal pharmacy  and  therapeutics.  Where  the  formulas  are  not  original, 
due  credit,  so  far  as  is  known,  has  been  given. 

It  is  unnecessary  to  profusely  illustrate  a  book  of  this  kind.  Only 
such  illustrations  as  will  tend  to  better  explain  the  subject  matter  of 
the  text  are  given.  These,  with  few  exceptions,  were  taken  from 
actual  cases  in  the  author's  practice,  or  from  private  patients  referred 
to  him  for  treatment. 

The  author  desires  to  express  his  grateful  appreciation  to  Dr.  E.  W. 
Elliot  for  valuable  suggestions,  to  Dr.  Lee  K.  Stewart  for  furnishing 
models  to  illustrate  a  practical  retaining  appliance,  and  to  other  pro- 
fessional friends  for  the  encouragement  given  in  undertaking  the  work. 
He  further  records  his  appreciation  of  the  publisher's  unfailing 
courtesy.  J.  P.  Buckley. 

Chicago,  November,  1909. 


CONTENTS. 


PART   I. 

DENTAL  MATERIA  MEDICA  AND  PHARMACOLOGY. 

Materia  Medica,  Pharmacology,  and  Therapeutics,  i. 
General  Considerations. 

Sources  of  Drugs,  and  Constituents  of  those  of  Vegetable  Origin,  4 
Parts  of  Plants  Used  for  Drugs,  6. 
Pharmaceutic  Preparations,  7. 

The    Solutions,  8. 

The  Mixtures,  10. 

Products  by  Extraction,  n. 

Mixtures  of  Solids,  15. 

Preparations  for  External  L'se,  16. 
Methods  of  Administering  or  Applying  Drugs,  19. 

By  the  Mouth,  20. 

Hypodermic,  20. 

Epidermic  or  Inunction,  23. 

Intravenous,  23. 

Cataphoresis,  24. 

By  the  Rectum,  24. 

Inhalation,  24. 
Conditions  Modifying  the  Effects  of  Drugs,  24. 

Habit,  24. 

Idiosyncrasy,  25. 
Tolerance. 

Cumulative  effect,  25. 

Dosage,  2  =;. 
Age. 
Sex. 

Pathologic  Conditions,  26. 

Climate  or  Temperature,  26. 

Method  and  Time  of  Administration,  26. 
Classification  of  Medicines,  27. 

Definitions  of  Remedies,  and  Examples  of  Each,  27. 
Drugs,  34. 

Local  Remedies,  34. 

Antacids,  34. 

Antiseptics,  Disinfectants,  and  Deodorants,  38. 

Astringents,  Styptics,  and  Hemostatics,  67. 

Bleachers,  83. 

Escharotics  or  Caustics,  88. 

Irritants  and  Counterirritants,  100 

Emollients,  Demulcents,  and  Protectives,  108. 

Local  Anesthetics,  118. 
General  Remedies,  131. 

General  Anesthetics,  131.  , 

Antipyretics,  136. 

Hypnotics,  140. 

Narcotics,  146. 

Stimulants,  1  54. 

Miscellaneous  Group,  i6q. 

Alteratives  and  Restoratives,  171. 

Digestants,  194. 

xi 


Xl  l  CONTENTS. 

Cathartics,  196. 
Diuretics,  211. 
Diaphoretics,  217. 
Emetics,  218. 
Expectorants,  221. 
Sialogogues,  223. 
Carminatives,  224. 
Flavoring  Agents,  228. 
Remedies  Other  than  Drugs,  232. 
Heat,  232. 

Thermometric  Scale,  233. 
Cold,  233. 

Compressed  Air,  234. 
Light,  234. 

Rontgen  or  X-ray,  235. 
Radium,  236. 
Electricity,  236. 
Cataphoresis,  236. 
Massage,  237. 
Suction,  237. 
Suggestion,  238. 
Metrology,  239. 

Systems  of  Weights  and  Measures,  239. 
Troy  or  Apothecaries'  Weight,  240. 
Wine  or  Apothecaries'  Measure,  240. 
Avoirdupois  Weight,  240. 
Approximate  Fluid  Measures,  241. 
Metric  System,  241. 

Metric  Weights,  243. 
Metric  Measures,  243. 
Equivalents,  243. 
Percentage  in  Solutions,  244. 
Prescription-writing,  246. 
Medical  Latin,  250. 

Examples  of  Practical  Prescriptions,  252. 
Incompatibility,  256. 

Antagonism  of  Drugs,  258. 

PART  II. 

PRACTICAL    DENTAL    THERAPEUTICS. 

Diseases  of  the  Hard  Tissues  of  the  Mouth  and  Associated  Structures,  261. 
Hypersensitive  Dentin,  261. 
Exposed  or  Nearly  Exposed  Pulps,  270. 

Capping  the  Pulp,  271. 
Removal  of  Pulps  and  Subsequent  Treatment,  275. 

In  Permanent  Teeth,  275. 

In  Deciduous  Teeth,  291. 
Nonseptic  Pericementitis,  293. 
Septic  Pericementitis,  305. 
Putrescent  Pulps,  298. 

Complications,  302. 
Alveolar  Abscesses,  305. 

Acute,  305. 

Chronic,  309. 

Complications,  313. 
Pericemental  Abscess,  322. 

Acute,  322. 

Chronic,  322. 
Putrescent  Pulps  and  Abscesses  in  Deciduous  Teeth,  320. 
Filling  of  Root  Canals,  324. 
Discolored  Teeth,  327. 

Outline  of  Chemical  Processes  of  Bleaching,  329. 

Methods  of  Bleaching,  329. 


CONTENTS.  XI 11 

Antrum  of  Highmore,  335. 
Surgical  Treatment,  336. 
Medicinal  Treatment,  338. 
Pyorrhea  Alveolaris,  339. 

Description  of  Classes,  339. 
Surgical  Treatment,  343. 
Medicinal  Treatment,  347. 
Local. 
ral. 
Mechanical  Treatment,  354. 
Neuralgia,  3  =;8. 

Facial  Xeuralgia,  358. 

.Medicinal  Treatment,  359. 
Local. 
General. 
Surgical  Treatment,  363. 
Tic  Douloureux,  363. 
Diseases  of  the  Soft  Tissues  of  the  Mouth,  Not  Directly  Associated  with  the 
Teeth,  365. 
Canker  Sores,  365. 
Herpes  Labialis  (cold  sores),  366. 
Syphilis,  367. 

Primary,  367. 
Secondary,  368. 
Tertiary,  370. 
Tuberculosis,  371. 
Stomatitis,  371. 

Mercurial,  371. 
Gonorrheal,  373. 
Leucoplakia  Buccalis,  371. 
Actinomycosis,  372. 
Acute  Ulcerous  Gingivitis,  372. 
Dental  Sterilization,  375. 

Method  of  Sterilizing  Instruments,  375. 
Index,  377. 


PART  I. 

MODERN  DENTAL  MATERIA  MEDICA,  PHARMA- 
COLOGY AND  THERAPEUTICS. 

Materia  medica  is  the  science  that  treats  of  drugs,  the  study 
of  which  includes  the  source,  constituents,  physical  and  chemic 
properties  of  the  inorganic  and  organic  materials  used  for  drugs. 

Pharmacology  is  the  science  that  treats  of  the  action  of  drugs 
upon  the  tissues,  organs  and  functions  of  the  body.  It  is,  therefore, 
the  study  of  the  changes  induced  in  living  organisms  by  the  adminis- 
tration of  such  substances  as  do  not  act  as  foods.  Formerly  this 
science  was  called  Pharmacodynamics.  That  part  of  Pharmacology 
devoted  to  the  study  of  Poisons  is  called  Toxicology. 

Therapeutics  is  the  science  that  deals  with  the  application  of 
drugs  or  remedies  to  the  treatment  of  disease. 

The  treatment  of  disease  based  solely  on  clinical  experience, 
whereby  remedies  are  administered  or  applied  without  reference  to 
their  physiologic  action,  is  known  as  empirical  therapeutics.  The 
application  of  the  essential  oils  to  the  canals  of  teeth  containing  putres- 
cent pulps,  or  the  giving  of  salicylic  acid,  sodium  salicylate  or  the 
lithium  salts  in  cases  of  pyorrhea  alveolaris,  supposed  to  be  associated 
with  rheumatism  or  gout,  are  examples  of  empirical  therapeutics. 

The  treatment  of  disease  by  the  employment  of  drugs  which, 
from  a  knowledge  of  their  physiologic  actions,  are  expected  to  counter- 
act certain  known  pathologic  conditions,  is  recognized  as  rational 
therapeutics.  The  application  of  remedies  containing  formaldehyd 
to  a  putrescent  root-canal,  wherein  it  is  expected  that  the  formaldehyd 
gas  will  neutralize  the  gaseous  end-products  of  pulp  decomposition, 
may  be  given  as  an  illustration  of  rational  therapeutics. 

While  it  is  essential  that  the  student  should  understand  at  the  very 
outset  the  definition  of  the  terms  materia  medica,  pharmacology  and 
therapeutics,  it  is  also  essential  that  other  general  terms  used  throughout 
the  text  should  be  thoroughly  mastered  at  this  time. 

A  medicine  is  any  substance  used  in  the  treatment  of  disease,     > 

A  drug  is  any  substance  which  may  be  used  as  a  medicine,  or  it 
may  be  used  purely  in  chemic  processes  and  not  directly  in  the  treat- 
ment of  disease. 


2  DEFINITION    OF    TERMS. 

A  remedy  is  a  broader  term  and  includes,  besides  material  sub- 
stances such  agents  or  means  employed  in  therapeutics  as  heat,  cold, 
light,  electricity,  massage  and  suggestion.  Remedies,  therefore,  may 
be  divided  as  follows: 

Prophylactic  Remedies. — Those  used  to  prevent  disease,  as 

polishing   tooth-surfaces   to   prevent   caries,    or   vaccination 

to  prevent  smallpox. 

Hygienic  Remedies. — Those  that  assist  in  the  maintenance 

of  health,  such  as  pure  air,  water,  food  and  bathing. 

Imponderable  remedies  include  heat,  cold,  light,  electricity, 

massage  and  suggestion. 

Mechanical  remedies  involve  the   use   of   bandages,  splints, 

instruments,  etc. 

Pharmacologic  remedies,  called  also  medicinal  remedies,  are 

the  material  substances,  or  medicines  used  in  the  treatment  of 

disease. 

There  are  several  closely  related  terms  employed  in  the  study  of 
the  practical  uses  of  remedies,  which  often  lead  to  confusion.  It  is 
well  that  the  student  understand  these  terms  at  the  very  outset. 
The  term  specific  has  a  double  meaning.  When  used  in  connection 
with  a  remedy  it  means  that  the  remedy,  if  used  in  the  proper  man- 
ner, can  generally  be  depended  upon  to  produce  definite  results  in 
certain  diseases.  For  example,  formocresol  is  a  specific  for  putrescent 
pulp  conditions;  antitoxin  is  a  specific  for  diphtheria.  There  are 
but  few  specific  remedies.  Applied  to  a  disease,  the  term  specific 
means  syphilis,  and  it  is  so  used  by  physicians  and  dentists  to  indi- 
cate that  disease  which  has  associated  with  it  the  stigma  of  vice. 
Therefore,  syphilis  is  generally  spoken  of  as  a  specific  disease. 

The  terms  physiologic  action,  physiologic  effect  and  thera- 
peutic effect  are  too  frequently  used  interchangeably,  without  refer- 
ence to  their  true  meaning.  There  is  a  distinction  between  the  action 
and  the  effect  of  a  drug.  Many  times  the  action  of  a  drug  is  obscure, 
but  the  effect,  if  produced,  must  necessarily  be  apparent.  This  is 
nicely  illustrated  by  the  inhalation  of  ammonia  in  cases  of  syncope 
(fainting).  The  action  of  the  ammonia  gas  is  that  of  an  irritant  on 
the  respiratory  mucous  membrane,  while  the  physiologic  effect  desired 
in  this  instance  is  cardiac  and  respiratory  stimulation.  This  is 
brought  about  reflexly  by  the  local  irritation;  for  ammonia,  thus  ad- 
ministered, produces  a  marked  increase  in  both  the  strength  and 
rapidity  ot  the  pulse  and  the  depth  and  rapidity  of  the  respirations. 


THE    UNITED    STATES    PHARMACOPEIA.  3 

In  the  case  mentioned  above,  the  therapeutic  effect  would  be  the 
return  of  consciousness,  which  might  not  follow  without  further  treat- 
ment. It  is  therefore  possible  to  have  the  physiologic  action  and 
effect  of  a  drug  without  the  therapeutic  effect. 

Resolution  is  a  term  which  indicates  the  return  of  an  abnormal 
to  a  normal  condition,  and  means  structural  recovery.  Dissolution 
is  a  term  which  means  death. 

The  author  desires  here  to  emphasize  the  importance  of  learning  the 
distinction  between  these  several  terms,  for  they  are  too  often  used 
synonymously,  without  reference  to  their  true  meaning. 

A  poison  is  any  substance  which,  when  administered  or  applied, 
by  its  inherent  physical  or  chemic  properties  causes  disease  or  death. 
That  branch  of  medical  science  which  treats  of  the  action  and  effects 
of  poisons,  their  detection,  and  the  treatment  of  the  conditions  resulting 
therefrom,  is  called  toxicology. 

Pharmacy  is  the  art  of  preparing,  compounding  and  dispensing 
medicines. 

The  Pharmacopeia  is  an  authoritative  work  which:  i.  estab- 
lishes standards  and  tests  for  the  identification,  quality,  purity  and 
strength,  and  2.  gives  directions  for  the  preparation,  purification  and 
preservation  of  drugs  and  medicines.  How  to  prepare,  purify  and 
preserve  medicines  is  the  work  of  the  pharmacist,  but  every  practising 
dentist  should  be  familiar  with  certain  standards  and  tests  for  the 
identity,  quality,  purity  and  strength  of  the  medicines  employed  in 
daily  practice. 

The  pharmacopeias  may  be  considered  the  medico-legal  authori 
ties  for  drugs  and  medicines  in  their  respective  countries. 

The  United  States  Pharmacopeia  (abbreviation,  "U.  S.  P.") 
is  prepared  by  a  committee  consisting  of  delegates  appointed  by  au- 
thority from  regularly  incorporated  medical  and  pharmaceutic  societies 
and  colleges.  This  pharmacopeial  committee  meets  at  the  beginning 
of  each  decade,  and  the  code  of  remedial  agents  thus  established 
is  intended  to  serve  as  a  standard  until  superseded  by  a  new  revision. 
The  last  (eighth)  edition  of  the  U.  S.  P.  became  the  official  standard 
September  1,  1905. 

A  dispensatory  is  a  commentary  on  the  pharmacopeia,  includ- 
ing, as  do  the  American  Dispensatories,  all  information  pertaining  to 
the  pharmacy  as  well  as  the  action  and  uses  of  medicines.  Dispensa- 
tories are  private  publications,  and  should  be  used  only  as  references, 
for  they  are  not  intended  to  take  the  place  of  the  standard  and  legal  au- 
thority— the  Pharmacopeia. 


4  SOURCES    OF    DRUGS. 

By  admitting  certain  articles  to  the  pages  of  the  U.  S.  P.,  it  declares 
them  to  be  of  sufficient  importance  as  to  merit  confidence  in  their  use 
in  the  practice  of  medicine.  Articles  thus  recognized  are  said  to  be 
"  official. "  This  should  not  be  taken  to  mean  that  articles  not  admitted 
are  valueless,  for  there  are  many  formulas  in  common  use  to-day  which 
are  exceedingly  valuable,  though  not  official.  The  American  Phar- 
maceutical Association,  recognizing  this  fact,  has  prepared  an  important 
collection  of  formulas,  which  is,  therefore,  in  a  sense  authoritative, 
called  the  National  Formulary  (abbreviation,  N.  F.),  and  which  will 
be  referred  to,  whenever-  occasion  requires,  throughout  this  work: 
however,  the  official  preparations,  or  a  combination  of  two  or  more, 
will  largely  furnish  the  basis  for  the  formulas  given  by  the  author  in 
that  part  of  the  book  devoted  to  practical  therapeutics. 

SOURCES  OF  DRUGS  AND  CONSTITUENTS  OF  THOSE 
OF  VEGETABLE  ORIGIN. 

Drugs  are  derived  from  the  three  kingdoms  of  nature — mineral, 
animal  and  vegetable.  Those  which  belong  to  the  mineral  kingdom 
are  called  inorganic  drugs,  and  are  obtained  by  chemic  processes 
directly  from  nature.  Organic  drugs  are  those  which  are  taken  from 
the  animal  and  vegetable  kingdoms.  The  element,  carbon,  plays  the 
leading  role  in  all  organic  drugs,  and  is  combined  in  the  compounds 
of  carbon  with  such  elements  as  hydrogen,  oxygen,  nitrogen,  and 
others. 

The  constituents  of  vegetable  drugs  of  value  in  medicine  and 
dentistry  are  called  the  active  principles,  and  they  include  carbohydrates, 
alkaloids,  glucosids,  neutral  principles,  organic  acids,  volatile  oils, 
resins,  gums,  fixed  oils  and  fats,  camphors  and  other  miscellaneous 
compounds. 

Carbohydrates  are  largely  used  as  foods,  yet  many  of  them,  owing  ' 
to  their  bland  and  soothing  action,  are  employed  as  medicines.     These 
include  starch  and  the  sugars. 

Alkaloids  are  nitrogenous  compounds,  having  the  reaction  and 
basic  properties  of  alkalies.  They  are  odorless,  have  a  bitter  taste,  and 
generally  possess  powerful  physiologic  actions.  Alkaloids  are  almost 
insoluble  in  water,  but  they  readily  combine  with  acids  to  form  crystal- 
lizable  salts  which  are  freely  soluble.  For  example,  cocain  is  an 
alkaloid,  and,  as  such,  is  not  largely  used  in  dental  practice;  but,  when 
acted  upon  by  hydrochloric  acid,  cocain  hydrochlorid  is  formed,  and 
this  alkaloidal  salt  is  one  of  our  most  useful  drugs. 


CONSTITUENTS    OF    VEGETABLE    DRUGS.  5 

Other  examples  of  alkaloids  are,  strychnin,  morphia,  alropin,  etc. 
The  term  artificial  alkaloid  i-  used  to  designate  secondary  alkaloids 
derived  from  natural  ones,  as  apomorphin,  which  is  obtained  by  ab- 
stracting from  morphin  a  molecule  of  water. 

Glucosids  comprise  those  vegetable  principles  which  may  be 
resolved  by  boiling  with  dilute  acid  or  alkalies,  or  by  the  action  of 
ferments,  into  glucose  and  one  or  more  other  products  peculiar  to  the 
substance  tested.  Glycyrrhizin,  obtained  from  liquorice-root,  and 
-alicin,  from  willow-bark,  are  examples. 

Neutral  principles  are  neutral  constituents,  differing  from 
alkaloids  in  not  being  basic  in  character  and  from  glucosid  in  not  being 
resolvable  into  glucose.  Aloin,  from  aloes,  and  piper  in,  from  black 
pepper,  are  examples. 

Organic  acids  are  found  in  many  plants,  either  free  or  combined 
with  alkaloids  or  inorganic  bases.  Those  of  most  value  in  dentistry 
are  acetic,  benzoic,  lactic,  salicylic,  oxalic,  and  tannic  acids. 

Volatile  oils,  also  called  essential  oils,  form  a  large  group  of 
organic  bodies,  from  which  they  are  chiefly  obtained  by  distillation. 
They  are  highly  odorous,  oily,  sparingly  soluble  in  water,  more  or  less 
soluble  in  alcohol  and  ether,  and  prone  to  become  resinous  on  exposure 
to  air.  In  the  past  the  volatile  oils  have  occupied  a  prominent 
place  in  dental  practice.  Those  to  be  remembered  are  the  oils  of 
cinnamon,  cloves,  peppermint,  winter  green,  turpentine,  eucalyptus,  and 
cajupiit. 

Resins  are  exudations  associated  with,  and  probably  derived 
from,  volatile  oils.  They  are  insoluble  in  water,  but  freely  soluble  in 
alcohol.  Examples  of  resins  are  those  of  jalap,  podophyllum  and 
common  rosin. 

Gums  are  dried  exudations  obtained  by  incising  the  limbs  and 
branches  of  certain  plants.  Gums,  contrary  to  resins,  are  insoluble  in 
alcohol,  but  freely  soluble  in  water.  The  most  important  gums  are 
those  of  acacia  and  tragacanth.  Ordinary  mucilage  is  a  solution  of 
certain  gums  in  water. 

Fixed  oils  and  fats  are  obtained  by  simple  pressure,  and  are  not 
readily  volatilized.  Those  used  chiefly  in  dentistry  are  lard,  lard  oil, 
olive  oil,  castor  oil,  and  oil  of  theobroma  (cacao  butter). 

Camphors  are  solid  and  crystallizable  bodies,  closely  associated  in 
plants  with  ter penes,  i.e.,  compounds  of  carbon  and  hydrogen  in  the 
proportion  CI0Hl6,  and  probably  derived  from  them  by  oxidation. 
The  principal  member  of  the  group  is  official  camphor,  CIOHl60. 
Stearoplens,  obtained  from  various  essential  oils,  as  menthol  and  eu- 


6  PARTS    OF    PLANTS    USED    FOR    DRUGS. 

calyptol,    are    sometimes    called    camphors,    but    should    not    be   so 
considered. 

Miscellaneous  compounds  are  such  proximate  principles  as  are 
not  referable  to  the  groups  mentioned.  They  include  several  com- 
pounds of  value  to  dentistry,  as  eucalyptol,  eugenol,  thymol  and 
guaiacol. 

PARTS  OF  PLANTS  USED  FOR  DRUGS. 

The  crude  organic  drugs  which  form  a  large  part  of  the  materia 
medica  are  chiefly  derived  from  the  vegetable  kingdom.  All  the 
different  parts  of  plants  are  used.  The  active  principle  is  often  dis- 
tributed throughout  the  entire  plant,  but  is  generally  found  more 
abundantly  in  one  particular  part,  which  is  then  used.  For  con- 
venience in  study,  the  parts  of  plants  used  for  drugs  can  be  divided  into 
portions  which  grow  under  and  above  the  ground. 

Portions  Under  Ground. — The  root  {radix)  proper  is  that  part 
of  the  plant-axis  which  does  not  bear  leaves.  Roots  are  ordinarily 
subterranean  (grow  underground)  in  their  habits,  and  serve  the 
double  use  of  attaching  the  plant  securely  to  the  soil  and  of  enabling  it 
to  absorb  from  the  latter  the  necessary  food.  The  roots  of  some  plants 
not  only  perform  these  functions,  but  become  greatly  thickened  and 
serve  also  for  the  accumulation  of  reserve  food  material  and  are  then 
called  tubers  (potato,  beet  and  turnips) .  Roots  possess  a  bark  which  is 
sometimes  used  separately  (sassafras).  If  the  underground  portion  of 
a  root  does  bear  leaves,  it  is  termed  rhizome  (rhizoma).  This  is  some- 
times called  a  subterranean  stem.  When  the  root-leaves  become  en- 
larged and  serve  as  storehouses  for  food,  a  bulb  (bulbus)  is  formed. 
The  onion  is  an  example.  The  lowest  part  of  the  stem  of  a  plant  is 
often  thickened,  and  is  then  called  corm  (cormus). 

Portions  Above  Ground. — When  the  entire  plant,  except  the 
root,  is  employed,  it  is  called  herb  iherba).  This  consists  of  stems, 
leaves,  and  often  flowers  or  fruit. 

The  stem  proper  is  that  part  of  the  plant-axis  which  bears  leaves  or 
some  modification  of  them.  Its  functions  are,  to  form  such  a  support 
for  the  leaves  as  will  duly  expose  them  to  the  influence  of  light  and  air, 
to  bear  the  floral  organs  and  convey  to  them  the  necessary  nutriment, 
and  to  form  a  means  of  communication  and  interchange  between  the 
roots,  or  organs  which  absorb  the  crude  nutritive  material  from  the 
soil,  and  the  leaves,  or  organs  which  assimilate  this  food.  With 
small,  herby  plants  the  stem  is  called  stipes;  with  larger  plants  it  is 


PHARMACEUTIC    PREPARATIONS.  7 

transformed  into  wood  (lignum)   and  is  covered   with   bark  (cortex). 

The  outer  layers  of  the  older  bark  are  always  corky,  and  a  secondary 
bark  develops  inside  of  this  which  is  called  liber. 

The  leaves  (folia)  are  stem-appendages,  regularly  arranged  upon 
the  stem,  and  consist  of  expansions  of  its  tissues.  Buds  may  be  con- 
sidered as  rudimentary  stems,  with  rudimentary  leaves  compactly  ar- 
ranged upon  them. 

The  flower  (flos)  is  a  special  modification  of  the  leaves.  It  con- 
sists of  the  calyx  (usually  green  parts  called  sepals)  and  a  corolla. 
The  latter  is  made  up  of  showy  leaflets  (petals)  and  the  inconspicuous, 
but  important,  male  and  female  elements  called  stamens  and  pistil, 
respectively.  The  stamens  bear  the  fertilizing  element  in  the  form  of 
granules,  termed  pollen.  The  pistil  consists  of  the  ovary,  which 
develops  the  seed  (semen),  and  the  style  and  stigma,  which  serve  tp 
receive  the  pollen.  After  fertilization  takes  place,  the  ovary  develops 
into  the  fruit  (fruclus);  this  may  also  involve  neighboring  parts,  es- 
pecially the  top  of  the  stem,  as  in  the  apple  and  strawberry.  The 
fruit  consists  of  the  outer  portion,  pericarp,  and  the  seeds.  The  latter 
contains  the  embryo  and  nutriment  material,  and  is  protected  by  a 
more  or  less  hard  shell.  Certain  organic  drugs  consist  of  the  coagu- 
lated juices  of  the  plants  and  show  no  structure  (opium,  etc.). 

PHARMACEUTIC  PREPARATIONS. 

Pharmaceutic  preparations  are  those  preparations  made  by  the 
pharmacists,  the  formula  being  given  for  their  preparation  in  the 
United  States  Pharmacopeia;  and  nearly  one-half  of  the  articles  of  the 
U.  S.  P.  are  pharmaceutic. 

The  pharmaceutic  preparations  may  be  classified  as  follows : 
I.    The  solutions. 
II.    The  mixtures. 

III.  Products  by  extraction. 

IV.  Mixtures  of  solids. 

V.  Preparations  for  external  use. 
These  groups  are  subdivided  into  a  number  of  classes,  each  class 
having  a  distinct  Latin  title  which  officially  designates  its  members,  or 
individual  preparations,  and  by  which  they  are  alphabetically  arranged 
in  the  U.  S.  P.  Besides  the  Latin  and  English  titles,  each  class  is 
also  known  by  an  English  name  and  various  synonyms.  The  stu- 
dent will  gradually  become  acquainted  with  the  various  classes  and 
names  of  each  by  carefully  studying  the  following  classification: 


8  PHARMACEUTIC    PREPARATIONS. 

I.  THE  SOLUTIONS. 

The  general  class  of  pharmaceutic  preparations  called  "The 
Solutions"  includes  nine  subclasses,  each  classified  according  to  the 
solvent  used. 

i.  Medicated  Waters. — Aquae  Medicatae.  Medicated  waters 
are  solutions  of  volatile  substances  in  water.  They  embrace  the  popular 
aqueous  solutions  of  the  volatile  oils  and  in  these  cases  are  made  by 
first  triturating  the  oil  writh  some  insoluble  substance,  as  talc,  precipi- 
tated calcium  phosphate,  or  magnesium  carbonate,  thus  dividing  the 
globules  of  the  oil  and  distributing  it  over  much  surface,  after  which 
water  is  added,  when,  by  filtering,  the  water  abstracts  from  the  mixture 
all  of  the  oil  that  it  is  capable  of  holding  in  solution.  These  medicated 
waters  are  so  popular  in  dental  practice  that  the  following  formula 
from  the  U.  S.  P.,  as  typical  of  this  class,  is  here  given: 

Cinnamon  Water. 

Oil  of  Cinnamon,  two  cubic  centimeters  (2  c.c. — 30  m.). 

Talc,  jour  grammes  (4  gm. — 1  dr.). 

Distilled  Water,  a  sufficient  quantity. 

To  make  one  thousand  cubic  centimeters  (1,000  c.c. — 1  qt.). 

Triturate  the  Oil  of  Cinnamon  with  the  Talc,  add  the  distilled 

Water,    gradually,    under    constant    trituration,    and    filter. — ■ 

U.  S.  P. 

The  waters  most  commonly  used  are: 

Ammonia  Water  (Aqua  Ammoniae). 

Camphor  Water  (Aqua  Comphorae). 

Cinnamon  Water  (Aqua  Cinnamomi). 

Hamamelis  (witch-hazel)  Water  (Aqua  Hamamelidis). 

Hydrogen  Dioxid  Water  (Aqua  Hydrogenii  Dioxidi). 

Peppermint  Water  (Aqua  Menthae  Piperitae). 

Rose  Water  (Aqua  Rosae). 

2.  Solutions. — Liquores.  These  preparations  are  solutions  of 
non-volatile  substances  in  water.  The  official  solutions  contain  only 
inorganic  salts. 

The  most  important  solutions  are: 

Antiseptic  Solution,  Mouth-wash  (Liquor  Antiseptici). 

Solution  of  Calcium  Hydroxid,  Lime-water  (Liquor  Calcis). 

Compound  Solution  of  Cresol  (Liquor  Cresolis  Compositus). 

Compound  Solution  of  Chlorin  (Liquor  Chlori  Compositus). 

Solution  of  Ferric  Subsulphate,  MonsePs  Solution  (Liquor  Ferri 

Subsulphatis). 

Solution  of  Formaldehyd,  Formalin  (Liquor  Formaldehydi). 


PHARMACEUTIC    PREPARATIONS.  9 

Compound  Solution  of  Iodin,  Lugol's  Solution   (Liquor  Iodi 

Compositus). 

Solution  of  Magnesium  Citrate  (Liquor  Magnesii  Citratis). 

Solution  of  Potassium  Ilydroxid  (Liquor  Potassii  Hydroxidi). 

Solution  of  Sodium  Ilydroxid  (Liquor  Sodii  Hydroxidi). 

Solution^  of  Chlorinated  Soda,  Labarraque's  Solution  (Liquor 

Soda;  Chlorinata-,  N.  F.). 

3.  Spirits. — Spiritus.  The  spirits  are  solutions  of  volatile  sub- 
stances in  Alcohol.  Of  the  twenty  official^  two  are  "natural"  spirits 
(made  by  distillation,  Whisky  and  Brandy),  fifteen  are  solutions  of  es- 
sential oils,  and  are  called  "Aromatic  Spirits"  or  "Essences." 

The  most  important  spirits  are: 

Spirit  of  Ammonia  (Spiritus  Ammoniae). 

Aromatic  Spirit  of  Ammonia  (Spiritus  Ammoniae  Aromaticus). 

Brandy  (Spiritus  Vini  Gallici). 

Spirit  of  Camphor  (Spiritus  Camphorae). 

Spirit  of  Cinnamon  (Spiritus  Cinnamomi). 

Compound    Spirits   of   Ether,    Hoffmann's   Anodyne  (Spiritus 

Athens  Compositus). 

Compound  Spirit  of  Juniper  (Spiritus  Juniperi  Compositus). 

Spirit  of  Myrcia,  Bay-rum  (Spiritus  Myrciae)  (Unofficial). 

Spirit  of  Nitroglycerin,  Spirit  of  Glonoin  (Spiritus  Glycerylis 

Xitratis). 

Spirit  of  Peppermint  (Spiritus  Menthae  Piperitae). 

Whisky  (Spiritus  Frumenti). 

4.  Syrups. — Syrupi.  Syrups  are  nearly  saturated  solution  of 
sugar  in  water,  in  which  medicinal  or  flavoring  agents  are  dissolved. 
The  most  important  syrups  are: 

Simple  Syrup  (Syrupus)  (85  per  cent.  Sugar). 
Syrup  of  Acacia  (Syrupus  Acaciae). 

Syrup  of  Calcium     Lactophosphate     (Syrupus     Calcii    Lacto- 
phosphatis). 

Syrup  of  Wild  Cherry  (Syrupus  Pruni  Virginianae). 
Syrup  of  Ginger  (Syrupus  Zingiberis). 

Compound    Syrup    of    Hypophosphites    (Syrupus    Hypophos- 
phitum  Compositus). 
Syrup  of  Ipecac  (Syrupus  Ipecacuanhas). 

Syrup   of   Iron,    Quinin   and    Strychnin  Phosphates  (Syrupus 
Ferri,  Quininae  et  Strychninae  Phosphatum). 
Compound  Syrup  of  Sarsaparilla  (Syrupus  Sarsaparills  Com- 
positus). 

Compound  Syrup  of  Squill,  Coxe's  Hive  Syrup  (Syrupus  Scillae 
Compositus). 
Syrup  of  Tolu  (Syrupus  Tolutanus). 


IO  PHARMACEUTIC    PREPARATIONS. 

5.  Honeys. — Mellita.  Honeys  are  solutions  of  certain  substances 
in  clarified  honey.     Honey  of  rose  (mel  rosae)  is  an  example. 

6.  Elixirs. — Elixiria.  Elixirs  are  solutions  containing  aromatic 
substances,  sugar,  alcohol,  and  water.  They  are  used  largely  to  mask 
the  taste  of  nauseating  drugs.     The  official  elixirs  are: 

Adjuvant  Elixir  (Elixir  Adjuvans). 

Aromatic  Elixir  (Elixir  Aromaticum). 

Elixir  of  Iron,  Quinin  and  Strychnin  Phosphates  (Elixir  Ferri, 

Quinine  et  Strychnine  Phosphatum). 

7.  Glycerites. — Glycerita.  Glycerites  are  solutions  of  medicinal 
substances  in  glycerin.     The  most  important  glycerites  are: 

Glycerite  of  Boroglycerin  (Glyceritum  Boroglycerini). 
Glycerite  of  Iron,  Quinin  and  Strychnin  Phosphates  (Glyceri- 
tum Ferri,  Quininae  et  Strychninae  Phosphatum). 
Glycerite  of  Phenol,   Glycerite  of  Carbolic  Acid   (Glyceritum 
Phenolis). 

Glycerite  of  Starch  (Glyceritum  Amyli). 
Glycerite  of  Tannic  Acid  (Glyceritum  Acidi  Tannici). 

8.  Oleates. — Oleata.  Oleates  are  solutions  of  metallic  oxids  or 
alkaloids  in  oleic  acid.     The  useful  oleates  are: 

Oleate  of  Cocain  (Oleatum  Cocainae). 
Oleate  of  Mercury  (Oleatum  Hydrargyri). 
Oleate  of  Quinin  (Oleatum  Quininae). 

9.  Collodions. — Collodia.  Collodions  are  solutions  of  medicinal 
substances  in  collodion;  i.e.,  gun-cotton  (pyroxylin)  dissolved  in  ether 
and  alcohol.  These  preparations  are  used  externally,  and  chiefly  as 
protectants.     The  important  collodions  are: 

Collodion  (Collodium). 

Cantharidal   Collodion,   Blistering  Collodion  (Collodium   Can- 

tharidatum). 

Flexile  Collodion  (Collodium  Flexile). 

Styptic    Collodion    (20   per   cent.    Tannic    Acid)    (Collodium 

Stypticum). 


II.  THE  MIXTURES. 

This  general  class  of  pharmaceutic  preparations  includes  such 
liquid  preparations  as  are  not  clear  solutions,  or  solutions  that  cannot 
be  classified  according  to  the  solvent  used.  There  are  three  sub- 
classes: 


PHARMACEUTIC    PREPARATIONS.  II 

i.  Mixtures. — Mistura.  Mixtures  are  liquid  preparations 
usually  holding  in  suspension  in  water  some  insoluble  substance. 
Mixtures  should  be  well  shaken  before  being  administered.  Examples 
of  official  mixtures  are: 

Mixture  of  Chalk  (Mistura  Cretae). 

Mixture  of  Rhubarb  and  Soda  (Mistura  Rhei  et  Sodae). 

2.  Emulsions. — Emulsa.  Emulsions  are  liquid  preparations 
consisting  of  oily,  fatty,  resinous,  or  otherwise  insoluble  substances, 
suspended  in  water  by  the  aid  of  some  gum  or  mucilage  called  the 
emulsifying  agent,  as  acacia  or  tragacanth.  Milk  and  the  yelk  of 
egg  are  natural  emulsions.     The  important  official  emulsions  are: 

Emulsion  of  Cod-liver  Oil  (Emulsum  Olei  Morrhuae). 
Emulsion  of  Oil  of  Turpentine  (Emulsum  Olei  Terebinthinae). 

3.  Liniments. — Linimenta.  These  are  liquid  preparations  for 
external  use,  consisting  of  solutions  of  oily  or  resinous  constituents  in 
alcohol  or  oils,  or  mixtures  of  liquid  soaps.  With  the  exception  of 
belladonna  liniment  and  lime  liniment,  which  are  used  as  sedative 
applications,  all  the  official  liniments  are  of  a  stimulating  character, 
and  should  be  applied  with  friction  or  massage.  The  useful  official 
liniments  are: 

Belladonna  Liniment  (Linimentum  Belladonnae). 

Lime  Liniment,  Carron  Oil  (Linimentum  Calcis). 

Camphor  Liniment  (Linimentum  Camphorae). 

Liniment  of  Soft  Soap,  Tincture  of  Green  Soap  (Linimentum 

Saponis  Mollis). 

III.  PRODUCTS  BY   EXTRACTION. 

The  medicinal  constituents,  called  active  principles,  of  crude  drugs 
are  obtained  by  extraction.  The  liquid  used  is  termed  the  menstruum, 
and  may  be  water  or  alcohol  or  both  in  varying  proportions,  with 
sometimes  the  addition  of  glycerin.  This  general  class  is  represented 
by  10  subclasses. 

1.  Mucilages. — Mucilagines.  These  are  solutions  of  gums  or 
other  mucilaginous  constituents  of  vegetable  drugs  extracted  with  an 
aqueous  menstruum.  They  are  used  as  emollients,  as  emulsifying 
agents  for  suspending  insoluble  substances  in  liquids,  and  as  excipients 
for  pills. 

The  official  mucilages  are: 

Mucilage  of  Acacia  (Mucilago  Acacias). 

Mucilage  of  Sassafras  Pith  (Mucilago  Sassafras  Medullas). 

Mucilage  of  Tragacanth  (Mucilago  Tragacanthae). 

Mucilage  of  Elm  (Mucilago  Ulmi). 


12  PHARMACEUTIC    PREPARATIONS. 

2.  Infusions. — Infusa.  Infusions  are  liquid  preparations  made 
by  pouring  boiling  water  on  vegetable  drugs  in  a  suitable  vessel  pro- 
vided with  a  cover,  allowing  it  to  stand  for  a  certain  period,  and  then 
straining.  Tea,  if  properly  made  by  the  housewife,  is  an  infusion. 
An  example  of  an  official  infusion  is: 

Compound  Infusion  of  Senna,  Black  Draught  (Infusum  Sennae 
Compositum). 

3.  Decoctions. — Decocta.  Decoctions  are  liquid  preparations 
made  by  pouring  boiling  water  on  vegetable  drugs  in  a  suitable  vessel 
provided  with  a  cover,  allowing  it  to  boil  for  a  certain  length  of  time, 
and  then,  when  sufficiently  cooled,  strain.  Coffee,  as  usually  made, 
is  a  decoction.     There  are  no  official  decoctions. 

4.  Vinegars. — Aceta.  Vinegars  are  liquid  preparations  made  by 
treating  vegetable  drugs  with  dilute  acetic  acid.  They  are  not  much 
used  in  dentistry.     Only  two  are  official: 

Vinegar  of  Opium  (Acetum  Opii). 
Vinegar  of  Squills  (Acetum  Scillae). 

5.  Wines. — Vina.  These  are  alcoholic  liquids  made  by  ferment- 
ing fresh  grapes.  Medicated  wines  are  made  by  extracting  the  soluble 
constituents  of  vegetable  drugs  with  white  wine  as  the  menstruum,  to 
which  10  to  15  per  cent,  of  alcohol  is  added  which  aids  in  extracting 
and  in  preserving  the  preparation.     The  official  wines  of  value  are: 

Wine  of  Coca  (Vinum  Cocae). 
Wine  of  Ergot  (Vinum  Ergotas). 
Wine  of  Ipecac  (Vinum  Ipecacuanhae). 
Wine  of  Opium  (Vinum  Opii). 
Red  Wine  (Vinum  Rubrum). 
White  Wine  (Vinum  Album). 

6.  Tinctures. — Tinctura.  These  are  alcoholic  or  hydroalcoholic 
solutions  of  the  soluble  constituents  of  crude  drugs  or  of  non-volatile 
substances  (except  iodin) .  Tinctures  are  the  simplest  form  of  alcoholic 
products  by  extraction,  and  as  a  class  have  no  uniform  strength.  From 
a  tincture  all  the  other  preparations  may  be  progressively  produced 
through  concentration  by  evaporating  the  menstruum,  as  follows: 

Fluid  extract  representing  a  uniform  drug-strength,  viz. :  1  troy 
ounce  in  1  fluidounce  (1  gram  in  1  c.c). 

Extract,  or  "solid  extract,"  a  semi-solid  mass  of  pilular  consistence 
of  no  uniform  drug-strength,  or  assayed  and  powdered  with  diluent,  to 
represent  a  certain  alkaloidal  strength  (opium  and  nux  vomica). 

Abstract,  or  "  powdered  extract, "  by  incorporating  sugar  of  milk 
with  the  extract  to  represent  one-half  the  weight,  or  twice  the  strength 
of  the  drug. 


PHARMACEUTIC   PREPARATIONS.  1 3 

Resins,  separation  of  the  resinous  constituents,  by  precipitation  in 
water  of  a  concentrated  alcoholic  tincture.  Three  of  the  most  im- 
portant tinctures  are  required  by  the  U.  S.  P.  to  be  assayed  as  they 
must  possess  a  certain  specified  alkaloidal  strength.  They  are  tincture 
of  opium,  tincture  of  deodorized  opium,  and  tincture  of  mix  vomica. 

Tinctures  are  applied  locally  or  administered  internally  by  dentists 
more  than  any  other  subclass  of  pharmaceutic  preparations.  The 
following  tinctures  are  among  the  most  important: 

Tincture  of  Aconite  (Tinctura  Aconiti). 

Tincture  of  Belladonna  Leaves  (Tinctura  Belladonna?  Foliorum). 

Tinctura  Benzoin  (Tinctura  Benzoini). 

Compound  Tincture  of  Benzoin  (Tinctura  Benzoini  Composita). 

Tincture  of  Indian  Cannabis  (Tinctura  Cannabis  Indica?). 

Tincture  of  Cantharides  (Tinctura  Cantharidis). 

Tincture  of  Capsicum  (Tinctura  Capsici). 

Tincture  of  Calendula  (Tinctura  Calendula?). 

Tincture  of  Cinchona  (Tinctura  Cinchona?). 

Compound  Tincture  of  Cinchona,  Huxhanvs  Tincture  (Tinctura 

Cinchona?  Composita). 

Tincture  of  Digitalis  (Tinctura  Digitalis). 

Tincture  of  Gelsemium  (Tinctura  Gelsemii). 

Compound  Tincture  of  Gentian  (Tinctura  Gentiana?  Composita). 

Tincture  of  Hyoscyamus  (Tinctura  Hyoscyami). 

Tincture  of  Iodin  (Tinctura  Iodi). 

Tincture  of  Krameria  (Tinctura  Krameria?). 

Tincture  of  Nux  Vomica  (Tinctura  Nucis  Vomica?). 

Tincture  of  Opium,  Laudanum  (Tinctura  Opii). 

Camphorated  Tincture  of  Opium,  Paregoric   (Tinctura  Opii 

Camphorata). 

Tincture  of  Rhubarb  (Tinctura  Rhei). 

Ammoniated  Tincture  of  Valerian   (Tinctura  Valeriana?  Am- 

moniata). 

7.  Fluid  extracts. — Fluidextracta.  These  are  concentrated 
tinctures  of  such  strength  as  to  represent  the  drug  volume  for  weight,  i.e., 
one  fluidounce  must  represent  the  active  principles  of  one  troy  ounce 
of  the  crude  drug  (i  c.c.  =  i  gram). 

The  preparations  in  this  class  are  prescribed  largely  by  physi- 
cians, for  they  possess  the  advantage  of  having  a  uniform  strength. 
They  are  not  employed  by  dentists,  however,  as  much  as  are  the 
tinctures.     The  most  important  fluid  extracts  are: 

Fluid  Extract  of  Indian  Cannabis  (Fluidextractum  Cannabis 

Indica?). 

Aromatic   Fluid  Extract   of  Cascara  Sagrada  (Fluidextractum 

Rhamni  Purshiana?  Aromaticum). 


14  PHARMACEUTIC  PREPARATIONS. 

Fluid  Extract  of  Cinchona  (Fluidextractum  Cinchonae). 
Fluid  Extract  of  Coca  (Fluidextractum  Cocae). 
Fluid  Extract  of  Ergot  (Fluidextractum  Ergotae). 
Fluid  Extract  of  Gelsemium  (Fluidextractum  Gelsemii). 
Fluid  Extract  of  Hydrastis  (Fluidextractum  Hydrastis). 
Fluid  Extract  of  Hyoscyamus  (Fluidextractum  Hyoscyami). 
Fluid  Extract  of  Nux  Vomica  (Fluidextractum  Nucis  Vomicae). 
Fluid  Extract  of  Senna  (Fluidextractum  Sennae). 

8.  Extracts. — Extracta.  These  are  soluble  active  principles 
of  vegetable  drugs  concentrated  by  evaporation  to  a  soft  solid.  They 
are  called  "solid"  extracts  to  distinguish  them  from  fluid  extracts. 
When  employed,  they  are  usually  dispensed  in  pills  or  capsules.  They 
have  no  uniform  drug  strength,  and  extracts  of  opium  and  extract  of 
nux  vomica  are  required  to  be  assayed.     The  important  extracts  are: 

Extract  of  Aloes  (Extractum  Aloes). 
Extract  of  Cinchona  (Extractum  Cinchonae). 
Extract  of  Hyoscyamus  (Extractum  Hyoscyami). 
Extract  of  Nux  Vomica  (Extractum  Nucis  Vomicae). 
Extract  of  Opium  (Extractum  Opii). 

9.  Abstracts. — Abstracta.  These  are  a  class  of  powdered 
extracts,  formerly  recognized  by  the  U.  S.  P.  (1880),  prepared  from 
the  extracts  by  the  addition  of  sufficient  sugar  of  milk  to  make  the 
product  represent  one-half  its  weight  of  the  crude  drug.  The  ab- 
stracts have  a  uniform  relation  to  the  drug  in  that  one  grain  represents 
two  grains  of  the  drug,  just  as  the  fluid  extracts  have  the  uniform  rela- 
tion of  representing  the  drug  volume  for  weight.  There  are  no  official 
abstracts.  An  ideal  abstract  can  be  made  from  tincture  of  valerian, 
as  the  volatile  oil  in  valerian  does  not  permit  of  evaporation  neces- 
sary for  an  extract.  Abstract  of  valerian  is  one  of  the  most  practical 
preparations  of  the  drug. 

10.  Oleoresins. — Oleoresinae.  There  are  natural  and  pharma- 
ceutic oleoresins.  The  natural  oleoresins  have  been  elsewhere 
considered.  The  pharmaceutic  oleoresins  are  semi-liquid  extracts, 
obtained  by  exhausting  oleoresinous  drugs  with  ether.  The  ether 
extracts  fixed  and  volatile  oils  from  drugs,  as  well  as  resins.  Oleo- 
resins are  not  used  in  dentistry  to  any  extent,  but  have  been  briefly 
considered  here  in  order  to  make  our  classification  complete.  An  ex- 
ample of  an  official  oleoresin  is: 

Oleoresin  of  Capsicum  (Oleoresina  Capsici). 

11.  Resins. — Resinae.  Resins  have  previously  been  considered 
under  the  constituents  of  drugs.     The  official  resins  may  be  divided 


PHARMACEUTIC    PREPARATIONS.  I  5 

into  the  i.  natural  resins,  2.  resins  obtained  from  oleoresins  by 
separating  the  volatile  oil  by  distillation,  and  3.  pharmaceutic  resins, 
prepared  by  precipitation.     An  example  of  an  official  resin  is: 

Resin  of  Podophyllum,  May  Apple  (Resina  Podophylli). 


IV.  MIXTURES  OF  SOLIDS. 

The  general  class  called  mixtures  of  solids  includes  several 
subclasses  of  pharmaceutic  preparations  for  internal  use: 

1.  Powders. — Pulveres.  These  are  impalpable  mixtures  of 
one  or  more  active  drugs,  usually  with  some  nearly  inert  substance, 
as  sugar  and  aromatics.  The  nearly  inert  substance  used  to  give 
bulk  to  official  powders  is  called  the  diluent.  The  important  powders 
are: 

Compound  Acetanilid  Powder  (Pulvis  Acetanilidi  Compositus). 
Compound  Powder  of  Chalk  (Pulvis  Cretae  Compositus). 
Powder  of  Ipecac  and  Opium,  Dover's  Powder  (Pulvis  Ipecacu- 
anhas et  Opii). 

Compound  Powder  of  Morphin,  Tully's  Powder  (Pulvis'  Mor- 
phinse  Compositus). 

Compound     Effervescent    Powder,     Seidlitz    Powder     (Pulvis 
Effervescens  Compositus). 

2.  Effervescent  Salts. — Sales  Effervescentes.  These  are  granu- 
lated mixtures  of  salts  with  sugar  and  sodium  bicarbonate  and 
tartaric  acid,  which  effervesce  when  the  mixture  is  added  to  water 
and  furnish  agreeable  aerated  draughts.  They  are  new  additions  to 
the  U.  S.  P.,  and  are  highly  useful  in  dentistry.     Those  official  are: 

Effervescent  Caffein  Citrate  (Caffeina  Citrata  Effervescens). 
Effervescent  Lithium  Citrate  (Lithii  Citrata  Effervescens). 
Effervescent  Magnesium  Sulphate  (Magnesii  Sulphas  Effervescens). 
Effervescent  Potassium  Citrate  (Potassii  Citrata  Effervescens). 
Effervescent  Sodium  Phosphate  (Sodii  Phosphas  Effervescens). 

3.  Confections. — Confectiones.  These  are  flavored  masses 
wherein  the  adhesive  substance  is  sugar  and  water,  or  honey,  serving 
as  a  vehicle  to  mask  the  taste  of  the  drug.     Only  two  are  official : 

Confection  of  Rose  (Confectio  Rosae). 
Confection  of  Senna  (Confectio  Sennae). 

4.  Troches  or  Lozenges. — Trochisci.  These  are  confections 
made  in  various  forms  and  dried.     Most  of  the  troches  are  intended 


1 6  PHARMACEUTIC    PREPARATIONS. 

to  influence   the  mucous  membrane  of  the  mouth  and  throat,  and  are 
useful  preparations.     The  most  important  are: 

Troches  of  Tannic  Acid  (Trochisci  Acidi  Tannici). 

Troches  of  Ammonium  Chlorid  (Trochisci  Ammonii  Chloridi). 

Troches  of  Krameria  (Trochisci  Krameriae). 

Troches  of  Potassium  Chlorate  (Trochisci  Potassii  Chloratis). 

Troches  of  Sodium  Bicarbonate  (Trochisci  Sodii  Bicarbonatis). 

5.  Masses. — Massae.  These  are  plastic  mixtures  preserved  in 
bulk  and  intended  for  forming  into  pills.     There  are  two  official: 

Mass  of  Ferrous  Carbonate,  Yallet's  Mass  (Massa  Ferri  Car- 

bonatis). 

Mass  of  Mercury,  Blue  Mass  (Massa  Hydrargyri). 

6.  Pills. — Pilulae.  These  are  spherical,  more  or  less  soluble 
masses  of  medicinal  substances  rendered  cohesive,  plastic,  and  firm 
in  consistence  by  the  addition  of  some  substance  (usually  inert),  called 
excipient.  The  kind  of  excipient  used  varies  with  the  nature  of  the  me- 
dicinal substance.  The  various  excipients  employed  are  water,  alcohol, 
glycerin,  syrups,  mucilage,  glucose,  glycerite  of  starch,  or  traga- 
canth,  etc. 

The  following  pills  are  important: 

Pills  of  Aloes  (Pilulse  Aloes). 

Compound  Cathartic  Pills  (Pilulae  Catharticae  Coinpositae). 

Pills  of  Carbonate  of  Iron,  Blaud's  Pills  (Pilulae  Ferri  Carbonatis). 

Pills  of  Opium  (Pilulae  Opii). 

Pills  of  Phosphorus  (Pilulae  Phosphori). 

7.  Tablets. — Tabellae.  These  are  small  disks  containing  me- 
dicinal substances  mixed  with  sugar  and  mucilage.  They  are  a  con- 
venient form  in  which  to  administer  potent  remedies,  such  as  the 
alkaloids,  calomel,  etc.  Blank  tablets,  i.e.,  those  containing  no  me- 
dicinal substance,  can  be  obtained  and  serve  as  a  pleasant  means  of 
administering  concentrated  liquid  preparations,  such  as  the  fluid  ex- 
tracts, by  dropping  from  two  to  five  minims  of  the  preparation  on 
the  tablet.     There  are  no  official  tablets. 

V.  PREPARATIONS  FOR  EXTERNAL  USE. 

This  class  of  pharmaceutic  preparations  include  such  products 
as  are  used  for  external  medication.  Liniments,  oleates,  and  collo- 
dions are  employed  externally,  but  being  true  solutions  are  classified  as 
such.     The  classification  of  the  groups  here  considered  is  based  upon 


PHARMACEUTIC   PREPARATIONS.  1 7 

the  fusibility,  or  melting-point,  of  the  preparations,  which  is  governed 
by  the  respective  vehicles  employed. 

i.  Ointments. — Unguenta.  These  are  mixtures  wherein  me- 
dicinal substances  are  incorporated  in  a  fatty  vehicle.  The  vehicles 
used  are:  Berizolated  lard,  lard  and  wax  or  spermaceti  in  varying 
proportions,  lard  oil,  olive  oil  and  suet.  Petrolatum  and  lanolin 
(wool-fat)  are  largely  used  in  unofficial  ointments.  The  following  are 
important  official  ointments: 

Ointment  of  Boric  Acid  (Unguentum  Acidi  Borici). 

Ointment  of  Tannic  Acid  (Unguentum  Acidi  Tannici). 

Ointment    of    Rose  Water,    Cold    Cream    (Unguentum    Aquae 

Rosae). 

Mercurial  Ointment  (Unguentum  Hydrargyri). 

Blue  Ointment  (Unguentum  Hydrargyri  Dilutum). 

Iodin  Ointment  (Unguentum  Iodi). 

Iodoform  Ointment  (Unguentum  Iodoformi). 

Ointment  of  Phenol,  Ointment  of  Carbolic  Acid  (Unguentum 

Phenolis). 

Ointment  of  Zinc  Oxid  (Unguentum  Zinci  Oxidi). 

Unofficial  ointments  in  use  are: 

Ointment  of  Arsenic  Trioxid,  Devitalizing  Paste  (Unguentum 
Arseni  Trioxidi). 

Ointment  of  Europhen  and  Orthoform,  Euro  form  Paste  (Un- 
guentum Europheni  et  Orthoformi). 
Ointment  of  Camphor  (Unguentum  Camphorae,  N.  F.). 

2.  Cereates. — Cereata.  These  are  mixtures  of  medicated  fats 
similar  to  ointments,  but  of  firmer  consistence  because  they  contain 
wax,  resin,  or  paraffin,  which  raises  the  melting-point.  The  im- 
portant official  cereates  are: 

Simple  Cereate  (Cereatum). 

Camphor  Cereate  (Cereatum  Camphorae). 

Cantharides  Cereate,  Blistering  Cereate  (Cereatum  Cantharidis). 

Important  unofficial  cereates  are: 

Compound    Cereate    of    Camphor,    Camphor    Ice    (Cereatum 
Camphorae  Compositum,  N.  F.). 

Cereate    of    Bismuth    Subnitrate,    Beck's    Cereate    (Cereatum 
Bismuthi  Subnitras). 

3.  Suppositories. — Suppositoria.  These  are  variously  shaped 
masses  of  medicated  fats,  intended  to  be  inserted  into  the  orifices  of 
the  body,  as  the  rectum,  vagina,  urethra,  or  nostril.     The  usual  vehicle 


1 8  PHARMACEUTIC   PREPARATIONS. 

is  oil  of  theobroma   (cacao  butter).     Suppositories  are  expected  to 
melt  at  body  temperature.     The  only  official  one  is : 

Suppository  of  Glycerin  (Suppositoria  Glycerini). 

4.  Plasters. — Emplastra.  Mixtures  of  solids  having  a  fatty  or 
resinous  vehicle,  and  of  such  high  melting-point  as  to  be  friable  when 
cold,  but  rendered  adhesive  by  the  warmth  of  the  body. 

The  vehicles  of  plasters  are:  Lead  plaster;  resinous  substances, 
made  adhesive  by  admixture  with  the  medicinal  ingredients,  and 
simple  plasters,  such  as  isinglass.     Important  official  plasters  are: 

Adhesive  Plaster  (Emplastrum  Adhesivum). 
Belladonna  Plaster  (Emplastrum  Belladonnas). 
Capsicum  Plaster  (Emplastrum  Capsici). 

An  unofficial  plaster  is: 

Isinglass  Plaster,  Court  Plaster  (Emplastrum  Ichthyocollae). 

5.  Papers. — Chartae.  These  are  strips  of  unsized,  white  paper 
saturated  or  coated  with  some  medicinal  substance.  They  are  in- 
tended to  be  moistened  and  applied  as  a  plaster,  or  else  to  be  burned 
and  the  fumes  inhaled.     Only  one  official: 

Mustard  Paper  (Charta  Sinapis). 

6.  Poultices. — Cataplasmata.  These  are  semi-liquid  prepara- 
tions made  by  mixing  such  coarsely  ground  substances  as  flaxseed,  elm- 
bark,  or  bread,  with  hot  water  or  milk.  They  are  spread  upon  cloth  or 
filled  into  porous  bags,  and  used  for  applying  heat  and  moisture  to 
the  tissues,  or  for  securing  a  local  stimulant  effect.  Charcoal  is  some- 
times added  as  an  absorbent  and  mustard  as  a  stimulant.  Only  one 
official: 

Cataplasm  of  Kaolin  (Cataplasma  Kaolini). 

7.  Fomentations. — Fomenti.  These  are  porous  woolen  cloths 
saturated  with  hot  infusion  or  decoction  of  herbs,  or  other  hot  liquids 
or  lotions  (saturated  solution  of  boric  acid),  and  applied  hot.  They 
are  useful  preparations,  but  none  official. 

8.  Absorbent  Cotton.— Gossypium  Purificatum.  The  hairs 
of  the  seed  of  cotton,  freed  from  oil  and  resinous  substances  by  treat- 
ment with  alkalies  and  bleaching  agents.  These  hairs  represent 
microscopic  ducts  through  which  liquids  are  absorbed  by  capillary 
attraction.     The  absorbability  of  cotton,  then,  depends  upon  its  purity, 


Ml  THODS    OF    ADMINISTERING    OR    APPLYING    DRUGS.  19 

or  the  freedom  from  oily  and  resinous  substances.     This  is  equally 
true  of  all  other  material  used  for  bandages. 

MISCELLANEOUS   LIST   OF   UNOFFICIAL   BANDAGES,    SPLINTS, 

MEDICATED  AND  ANTISEPTIC  DRESSINGS,  AND 

MEDICATED  GAUZES. 

Bandages. — These  are  mechanical  supports,  serving  also  to 
keep  wounds  clean  by  absorbing  and  withdrawing  such  secretions  as 
would  otherwise  prove  irritating,  and  by  protecting  the  wound  from 
extraneous  matter,  thus  promoting  the  process  of  healing. 

Plaster-of-Paris  bandages  are  made  by  thoroughly  incorporat- 
ing a  good  quality  of  plaster  of  Paris  (calcium  sulphate)  into  linen 
bandages.  After  the  bandage  is  adjusted,  water  is  applied,  when  it 
sets  in  a  few  minutes. 

Splints. — These  are  mechanical  supports  made  from  wood, 
metals  (gold,  platinum,  lead,  German  silver,  etc.),  and  vulcanite  rubber. 
They  serve  the  purpose  of  holding  in  proper  position  or  alignment 
fractured  bones  and  loosened  teeth.  The  metallic  splints  are  especially 
useful  in  orthodontia  and  pyorrheal  treatment. 

Medicated  and  Antiseptic  Dressings. — These  are  made  by 
saturating  such  materials  as  cotton,  silk,  wool,  or  asbetos  fiber  in  a 
certain  strength  of  solution  of  the  medicinal  agent,  or  by  incorporating 
the  latter  in  powdered  form.  The  fabric,  which  conveys  the  agent, 
simply  serves  as  a  vehicle  for  the  medicinal  or  antiseptic  drug.  This 
means  is  largely  employed  in  the  application  of  medicines  to  the  canals 
of  teeth. 

Medicated  Gauzes. — The  material  used  in  making  medicated 
gauzes  is  pure  muslin  gauze,  which  is  thoroughly  saturated  with 
a  certain  strength  solution  of  the  medicinal  substance  desired,  then 
forcibly  expressed,  after  which  it  is  ready  for  use.  Medicated  gauzes 
should  be  kept  in  tightly  covered  boxes  or  jars  in  a  cool  dry  place.  The 
following  gauzes  are  in  common  use: 

Borated  Gauze.  Iodoform  Gauze. 

Phenolized  Gauze.  Euroform  Gauze. 

METHODS  OF  ADMINISTERING  OR  APPLYING 

DRUGS. 

The  physiologic  and  therapeutic  effect  of  remedies  is  often  largely 
determined  by  the  methods  in  which  they  are  administered  or  applied; 
and  it  is  a  well-established  principle  that  the  nearer  the  remedy  is 


20  METHODS    OF   ADMINISTERING    OR   APPLYING    DRUGS. 

applied  to  the  site  of  the  disease  the  more  effectual  and  safer  is  its  use. 
Recognizing  this  principle,  remedies  should  be  applied  locally  as  far 
as  possible.  There  are  many  pathologic  conditions,  however,  confront- 
ing the  dentist  which  cannot  be  reached  and  acted  upon  favorably  by 
the  local  application  of  medicines.  It  is,  therefore,  the  plain  duty  of 
every  practitioner  of  dentistry  to  so  familiarize  himself  with  drugs 
and  their  internal  administration  that  he  will  be  able  to  treat  success- 
fully any  case  which  arises  in  his  practice. 

By  the  Mouth. — This  is  the  original  and  most  common  method 
employed  for  the  administration  of  the  great  majority  of  medicines. 
Drugs  are  given  by  the  mouth  for  their  local  action  on  the  mucous 
membrane  and  deeper  seated  tissues  of  the  mouth,  throat,  stomach,  or 
intestines  or  for  the  purpose  of  being  absorbed.  The  absorption  of 
drugs  may  take  place  from  any  part  of  the  alimentary  canal.  Some 
powerful  remedies  are  readily  absorbed  from  the  tongue.  A  dose  of 
spirit  of  nitroglycerin,  placed  under  the  tongue,  will  produce  its 
physiologic  effect  in  from  three  to  five  minutes.  Remedies  intended 
to  influence  the  mouth  or  throat  are  often  given  in  the  form  of  a  troche 
or  lozenge.  When  absorption  of  the  remedy  from  the  stomach  is 
desired,  it  should  be  administered  in  solution  or  in  such  condition  as  to 
be  acted  upon  by  the  gastric  secretions  and  made  soluble.  The 
reaction  of  the  gastric  juice  is  acid,  while  the  intestinal  juices  are 
alkaline.  Any  substance,  therefore,  soluble  in  either  an  acid  or  alkaline 
medium,  is  acted  upon  favorably  by  the  secretions  of  the  stomach  or 
intestines.  Such  remedies  as  calomel,  salol,  and  salophen,  requiring 
an  alkaline  liquid  for  their  solution,  pass  through  the  stomach  practi- 
cally unchanged,  and  are  digested  and  absorbed  almost  entirely  in  the 
intestines.  The  general  rule  for  administering  remedies  intended  to  be 
absorbed  in  the  stomach  is  to  give  them  on  an  empty  stomach,  that  is, 
half  an  hour  or  an  hour  before  meals.  This  rule  should  not  be  fol- 
lowed, however,  in  the  case  of  remedies  having  a  local  irritant  action, 
as  potassium  bromid  or  potassium  iodid,  etc.  It  is  far  better  to  give 
these  remedies  well  diluted  in  water,  and  immediately  after  meals,  so 
that  their  local  effect  is  more  or  less  avoided  by  becoming  mixed  with 
the  food. 

Hypodermic. — This  method  consists  in  injecting  solutions  of 
medicinal  substances  into  the  gum  and  subcutaneous  tissues  by  means 
of  the  hypodermic  needle  and  syringe,  and  is  largely  employed  in 
dental  practice.  The  method  has  many  advantages,  such  as  the  great 
rapidity  with  which  absorption  is  effected,  for  local  medication,  and 
the  certainty  of  securing  the  action  of  the  entire  dose.     The  alkaloidal 


METHODS   OF  ADMINISTERING   OR  APPLYING  DRUGS.  21 

salts,  as  cocain  hydrochloric!,  on  account  of  their  small  bulk,  are  es- 
pecially adapted  for  hypodermic  use.  The  dose  of  a  drug  given 
hypodermically  is  generally  about  one-half  that  given  by  the  mouth  or 
stomach.  There  are  several  conditions  wherein  the  hypodermic 
methods  of  administering  drugs  is  strongly  indicated,  viz. : 

i.  In  conditions  where  the  patient  is  unable  to  swallow,  or  where 
the  stomach  is  unable  to  receive  or  retain  medicines. 

2.  In  conditions  necessitating  the  immediate  action  of  a  drug  or 
remedy,  or  where  absolute  certainty  of  the  dose  is  desired. 

3.  In  conditions  where  local  medication  is  desired  for  the  pro- 
duction of  local  anesthesia,  for  the  relief  of  pain,  as  in  neuralgia,  or  for 
stimulation  of  a  deep-seated  part. 

The  first  two  indications  mentioned  for  this  method  of  administer- 
ing drugs  are  of  interest  to  dentists  in  that  the  method  is  employed  here 
in  cases  of  emergency  as  in  collapse.  The  third  indication  is  of 
prime  importance,  as  it  is  employed  every  day  in  a  busy  practice  for 
the  purpose  of  injecting  local  anesthetics  and  other  drugs  for  the 
mitigation  of  pain. 

The  factors  to  be  remembered  in  using  this  method  are: 

1.  Guard  against  septic  infection. 

2.  Prevent  the  injection  of  air  into  a  vein. 

3.  Prevent  the  injection  of  the  medicine  into  a  vein,  unless  in  cases 
of  emergency. 

To  guard  against  septic  infection,  it  is  necessary  to  have  the  hands 
and  the  field  of  operation  as  nearly  sterile  as  they  can  be  made  and  to 
have  the  hypodermic  syringe,  needle,  and  the  solution  absolutely  sterile. 

To  prevent  injecting  air  into  a  vein,  it  is  essential  that  all  of  the  air 
should  be  exhausted  from  the  syringe  before  the  injection  is  made. 
When  the  syringe  is  filled  by  drawing  the  solution  into  it,  hold  the  point 
upward,  tapping  the  side  of  the  syringe  gently  to  dislodge  any  air 
bubbles,  then  by  pushing  the  piston  until  the  solution  escapes,  the  air  is 
expelled.  There  is  little  danger  of  injecting  air  into  a  vein  when  the 
solution  is  injected  into  the  gum  tissue;  nevertheless,  it  is  well  to  avoid 
injecting  air  into  the  tissues,  and  when  this  method  of  drug  administra- 
tion is  used  other  than  with  gum  tissue,  the  danger  is  correspondingly 
increased.  If  air  enters  a  vein  it  is  carried  directly  to  the  right  side 
of  the  heart,  where  by  the  action  of  the  tricuspid  valve  it  forms  a  foam 
with  the  blood,  resulting  in  air-thrombosis,  which  might  cause  death. 

Occasionally  in  an  emergency  it  is  desired  to  inject  the  medicine 
into  a  vein  that  it  may  be  at  once  carried  to  the  heart;  but  ordinarily 
this  should  be  avoided.     To  unintentionally  inject  the  entire  quantity 


22  METHODS  OF  ADMINISTERING   OR  APPLYING  DRUGS. 

into  a  vein  might  result  in  an  overdose.  By  injecting  slowly  and 
holding  the  finger  over  the  needle-point,  one  can  readily  guard  against 
this  danger.  If  the  fluid  accumulates,  which  should  be  easily  detected 
by  the  finger,  nothing  need  be  feared;  but  if  the  fluid  escapes  readily 
and  the  accumulation  cannot  be  detected,  one  may  suspect  that  a 
vein  has  been  punctured.  In  this  case  the  needle  should  be  slightly 
withdrawn  and  the  injection  continued. 

The  Hypodermic  Syringe. — There  are  many  varieties  of  hypo- 
dermic syringes  on  the  market.  It  is  difficult  to  thoroughly  sterilize 
the  old-style  glass  barrel  and  leather-covered  piston  syringe,  and,  al- 
though it  has  the  advantage  of  permitting  a  view  of  the  fluid  or  air 
within  the  barrel,  the  ease  with  which  the  all-metal  syringe  can  be 
sterilized  and  its  ever-readiness  for  use  make  this  style  of  syringe  far 
preferable.  The  syringe  should  be  of  sufficient  size  to  permit  con- 
siderable pressure  in  making  the  injection.  There  are  a  variety  of 
needles  also.  The  operator  should  select  and  keep  on  hand  the 
kinds  which  best  meet  his  daily  need. 

Technic  of  the  Injection. — The  method  of  injecting  medicines 
hypodermically  differs  somewhat  with  the  site  of  application;  there- 
fore, it  will  be  discussed  under  different  headings: 

i.  Through  the  skin  into  the  cellular  tissue  of  the  body. 

2.  Through  the  mucous  membrane  into  the  gum  tissue  and  peri- 
cemental membrane. 

3.  Through  the  tooth  structure  into  the  pulp  tissue. 

In  injecting  drugs  hypodermically  through  the  skin  it  is  essential  to 
guard  against  the  dangers  incident  to  this  method  of  administering 
medicine.  The  solution  should  be  sterile  to  begin  with,  the  syringe  (all 
metal)  and  needle  may  be  sterilized  by  boiling,  the  hands  by  washing 
with  green  soap  and  followed  with  an  application  of  alcohol  (60  to  70 
per  cent.),  1-1000  solution  of  mercuric  chlorid,  or  1-500  solution  of 
sublamin;  the  site  of  application  may  be  sterilized  in  the  same  manner 
as  the  hands.  The  selection  of  the  site  for  making  the  injection  depends 
upon  the  circumstances  of  the  case.  It  may  be  made  upon  any  access- 
ible part  of  the  body,  usually,  however,  the  arm  or  lumbar  region  of 
the  back.  After  exhausting  the  air  from  the  syringe,  hold  firmly 
in  the  right  hand,  and  with  the  left  grasp  the  skin  at  the  selected  site. 
The  needle  should  now  be  pushed  quickly  through  the  skin  at  nearly 
right  angles  to  the  surface,  and  should  penetrate  quite  deeply.  The 
injection  should  be  made  slowly  and  with  the  forefinger  of  the  left 
hand  determine  whether  it  is  causing  distention  of  tissue  or  escaping 
rapidly. 


METHODS    OF    APPLYING    OR   ADMINISTERING    DRUGS.  23 

The  dentist,  as  has  been  intimated,  is  particularly  interested 
in  the  technic  of  injecting  drugs  hypodermically  through  the  mucous 
membrane  and  into  the  gum  tissue  for  the  purpose  of  producing  local 
anesthesia.  Before  undertaking  any  surgical  operation  the  mouth 
should  be  rinsed,  or,  better,  sprayed  with  an  antiseptic  solution.  The 
solution,  syringe,  needle,  and  hands  of  the  operator  should  be  steril- 
ized as  before.  In  sterilizing  the  field  of  operation  here,  alcohol  is 
an  excellent  agent  to  use.  The  immediate  point  through  which  the 
needle  passes  can  be  touched  with  a  drop  of  phenol  (95  per  cent.), 
using  a  sharp  pointed  glass  rod  or  a  toothpick.  This  further  steril- 
izes the  spot  and  slightly  anesthetizes  it;  thus  the  initial  pricking  of 
the  needle  is  scarcely  felt.  This  is  far  better  than  the  customary  prac- 
tice of  dipping  the  needle  point  into  phenol,  with  the  liability  of  getting 
some  of  the  agent  on  the  barrel  of  the  syringe,  and,  if  unnoticed,  on  the 
patient's  lip.  The  left  hand  is  used  in  holding  the  lip  and  cheek 
out  of  the  way,  and  with  the  syringe  in  the  right  hand,  held  at  an  angle 
of  about  forty-five  degrees  to  the  long  axis  of  the  tooth,  the  mucous 
membrane  is  punctured,  having  the  bevel  of  the  needle  facing  the 
tooth.  A  drop  of  the  fluid  is  now  deposited,  and  after  waiting  just  a 
moment,  further  injection  is  painless.  With  the  left  forefinger  pres- 
sure can  be  made  over  the  needle-point,  thus  forcing  the  fluid  into  the 
tissues  and  anesthetizing  the  part  with  a  minimum  amount  of  solution. 
If  the  needle  is  ultimately  passed  through  the  gum  and  enters  the 
pericemental  membrane  at  the  extreme  border  of  the  alveolar  process, 
in  the  region  of  the  so-called  dental  ligament,  the  solution,  with  a 
strong  syringe,  can  often  be  forced  through  the  membrane,  completely 
anesthetizing  it  to  the  apex  of  the  root.  This  is  generally  much  more 
satisfactory  than  making  the  injection  nearer  the  apex  of  the  root 
and  endeavoring  to  force  the  solution  through  the  bone  lamella. 

The  forcing  of  local  anesthetic  agents  through  the  loath  structure 
and  into  the  pulp  is  known  as  pressure  anesthesia  and  is  elsewhere 
considered. 

Epidermic  or  Inunction. — This  method  consists  in  applying 
medicinal  substances,  dissolved  in  fatty  vehicles,  to  the  unbroken  skin 
when  absorption  of  the  remedy  is  fairly  well  brought  about,  especially 
if  friction  be  used  in  their  application.  Ointments  are  largely  employed 
in  this  manner. 

Intravenous. — This  method  is  used  in  great  emergency  where 
it  is  desired  to  inject  a  stimulating  or  restorative  agent  directly  into  a 
vein.  Normal  saline  solution  (6  parts  of  sodium  chlorid  in  1,000  parts 
of  sterile  water — 6  grams  in  1,000  c.c.)  is  the  remedy  mostly  employed 


24     CONDITIONS    MODIFYING    THE   ACTION    AND    EFFECT    OF    DRUGS. 

in  this  manner.  The  solution  is  intended  to  correspond  to  blood 
serum  in  salinity,  and  is  given  intravenously  in  cases  of  copious  hemor- 
rhage, or  in  collapse. 

Cataphoresis. — This  method  consists  in  the  introduction  of 
drugs  in  molecular  form  into  tooth  structure  or  living  tissue  by  means 
of  the  electric  current.  The  positive-pole  applicator  is  saturated  with 
a  concentrated  solution  of  the  drug  and  placed  into  a  cavity  in  the  tooth 
being  treated,  or  directly  over  the  part  to  be  medicated,  the  negative 
pole  being  placed  somewhere  on  the  patient's  body,  usually  held  in  the 
hand  by  means  of  a  moist  sponge.  This  method,  with  cocain  hydro- 
chlorid  as  the  drug,  has  been  used  to  obtund  sensitive  dentin  and  to 
anesthetize  the  dental  pulp  for  the  purpose  of  its  painless  removal. 
The  method  will,  therefore,  again  be  considered  more  in  detail  later. 

By  the  Rectum. — This  method  is  employed  for  the  administra- 
tion of  both  medicines  and  food,  wherever,  on  account  of  inability  to 
swallow  or  persistent  vomiting,  the  mouth  or  stomach  route  cannot 
be  used.  Absorption  through  the  rectum  is  not  nearly  so  rapid  as 
through  the  stomach,  hence  to  accomplish  the  same  result  it  generally 
requires  twice  the  dose  by  the  rectum  that  would  be  necessary  by  the 
mouth,  and  solution  of  the  drug  should  be  assured  before  it  is  admin- 
istered, unless  a  local  effect  is  intended.  For  local  medication  sup- 
positories are  largely  employed. 

Inhalation. — This  method  can  only  be  employed  for  volatile 
drugs  or  finely-atomized  liquids.  Volatile  drugs  are  rapidly  absorbed 
from  the  respiratory  tract,  and  this  method  is  largely  used  in  dental 
practice  for  the  administration  of  such  drugs  as  nitrous  oxid,  chloro- 
form, and  ether,  when  the  general  analgesic  or  general  anesthetic 
effect  is  desired.  The  stimulating  effect  of  such  drugs  as  ammonia 
and  amyl  nitrite  is  also  produced  by  inhalation.  When  it  is  desired  to 
influence  directly  the  mucous  membrane  of  the  mouth  and  respiratory 
tract,  medicated  vapors  and  sprays  are  often  employed. 

CONDITIONS  MODIFYING  THE  ACTION  AND 
EFFECT  OF  DRUGS. 

There  are  many  conditions  or  circumstances  which  influence  and 
modify  the  action  and  effect  of  drugs,  chief  of  which  are  the  age  of 
the  patient,  sex,  race,  size,  temperament,  disease,  temperature,  habit, 
idiosyncrasy,  method  and  time  of  administration,  preparation  of  the 
drug,  and  dose. 

Habit. — The  tissues  of  the  body  can  be  induced  to  tolerate  many 


CONDITIONS  MODIFYING  THE  ACTION  AND  EFFECT  OF   DRUGS.      25 

drugs  by  their  continuous  administration.  This  is  particularly  true 
of  opium  and  cocain.  It  is  not  definitely  known  just  how  this  condition 
is  brought  about,  but  it  is  believed  to  be  largely  due  to  a  change  in  the 
tissues  themselves  whereby  they  are  rendered  less  suitable  to  the 
influence  of  the  drug.  There  is  a  crying  demand  to-day  for  painless 
dentistry,  and  most  dental  operations  can  be  made  practically  painless 
by  the  judicious  use  of  narcotic  drugs,  especially  cocain.  Therefore, 
a  word  of  caution  here  regarding  the  danger  of  forming  the  drug-habit 
will  not  be  out  of  place.  This  habit  is  far  more  common  than  is 
generally  known.  It  is  the  duty  of  every  dentist  to  employ  such  reason- 
able measures  as  will  mitigate  pain,  but  he  should  constantly  guard 
his  patient  as  well  as  himself  against  the  formation  of  the  drug  habit. 

Idiosyncrasy. — This  is  a  peculiar  susceptibility  or  insusceptibility 
of  one  or  more  of  the  tissues  of  the  body  to  the  influence  of  certain  drugs 
for  which  no  explanation  can  be  found.  Less  than  1/4  of  a  grain  of 
calomel  has  been  known  to  induce  salivation,  causing  an  inflammation 
in  the  pericemental  membrane  and  teeth  sore  to  pressure.  With  some 
individuals  the  smallest  dose  of  quinin  will  produce  a  diffuse  erythem- 
atous rash.  Many  patients  have  an  idiosyncrasy  for  cocain,  the 
smallest  amount  causing  all  of  the  toxic  symptoms  characteristic  of  the 
drug.  Other  patients  have  what  may  be  called  a  presupposed  idiosyn- 
crasy, for  cases  are  on  record  where  the  patient  had  all  the  symptoms 
of  cocain-poisoning  when  only  distilled  water  had  been  hypodermically 
injected,  the  patient,  however,  thinking  cocain  had  been  used. 

One  form  of  idiosyncrasy  consists  in  the  failure  of  the  individual 
to  react  to  the  ordinary  dose  of  the  drug,  and  this  particular  form  is 
called  Tolerance. 

Cumulative  Effect. — This  is  another  phenomenon  of  drugs 
caused  by  their  prolonged  administration  when  sudden  and  oftentimes 
a  severe  effect  is  produced,  owing  to  the  accumulation  of  the  drug  in 
the  tissues  of  the  body.  Cumulative  action  may  occur  along  with 
tolerance. 

Dosage. — Under  this  heading  can  be  discussed  most  of  the  condi- 
tions which  modify  the  effect  of  drugs  not  previously  considered,  for 
whatever  modifies  the  effect  of  drugs  must  also  necessarily  influence 
dosage.  In  regard  to  dosage  Butler «  says :  "  Common  sense  ought  long 
since  to  have  told  us  that  the  doses  prescribed  in  text-books  are  only 
based  upon  experience  in  certain  cases,  or  upon  experimentation  made 
upon  animals.  From  such  data,  however,  the  first  author  who  wrote 
upon  the  posology  of  different  substances  started,  and  others  have 

1  Text-book  of  Materia  Medica,  Therapeutics,  and  Pharmacology,  p.  46. 


26     CONDITIONS   MODIFYING   THE  ACTION  AND  EFFECT   OF  DRUGS. 

simply  copied  after  the  first.  If  any  fact  went  beyond  the  well- 
defined  limits,  it  was  wont  to  be  explained  by  the  defective  quality  or 
method  of  preparation  of  the  drug,  or  by  an  idiosyncrasy  so  rare  that 
one  would  not  even  take  the  pains  to  investigate  the  matter,  and  see  if  it 
were  really  less  rare  than  had  been  believed."  .While  there  is  perhaps 
a  maximum  and  a  minimum  dose  for  the  various  drugs,  the  dose  of  a 
remedy  should  be  governed  largely  by  the  conditions  found  at  the  time 
the  diagnosis  is  made  and  the  medicine  prescribed,  taking  into  con- 
sideration the  various  circumstances  which  influence  the  action  and 
effect  of  drugs. 

The  age  of  a  patient  must  be  taken  into  account  in  the  internal 
administration  of  drugs.  Children  ought  to  receive  much  smaller 
doses  than  adults.  Young  calculates  the  dose  for  a  child  according  to 
the  following  formula:  Divide  the  age  by  the  age +  12,  the  fraction 
obtained  is  taken  as  the  proportion  of  the  adult  dose  required.  Thus, 
for  a  child  four  years  old,  the  dose  would  be  (^p^  =)  1/4  of  the  adult 
dose,  for  a  child  twelve  years  old  (I2+V2  = )  1  / 2  of  the  adult  dose. 

In  regard  to  the  sex,  women  require  somewhat  smaller  doses  than 
men.  During  pregnancy,  purgative  drugs,  or  preparations  of  ergot  used 
frequently  in  dental  practice  in  cases  of  hemorrhage  after  extraction, 
have  to  be  used  with  the  greatest  care,  because  purgatives  induce  con- 
gestion of  the  pelvis,  and  ergot  acts  directly  upon  the  muscular  walls  of 
the  uterus,  causing  contraction,  either  of  which  conditions  may  lead  to 
abortion.  Many  drugs  also  pass  from  the  mother  to  the  child,  and 
this  should  be  remembered,  as  quantities  which  are  insufficient  to 
poison  the  former  may  have  serious  effects  upon  the  latter.  During 
lactation,  it  should  be  borne  in  mind  that  many  active  drugs  may  be 
excreted  in  the  milk,  and  may  either  act  on  the  child  or  render  the  milk 
distasteful  to  it. 

Pathologic  conditions  very  often  modify  the  effects  of  drugs  to  a 
considerable  extent,  and  in  a  way  which  pharmacologists  at  present 
cannot  explain.  As  an  example  of  this,  the  antipyretics  reduce  the 
temperature  in  fever,  but  have  no  effect  on  it  in  health;  bromids  lessen 
the  convulsions  in  epilepsy,  or  during  the  teeth-erupting  period  in 
children,  but  have  much  less  effect  in  depressing  the  brain  in  normal 
persons.  Strange  as  it  may  seem  to  the  student  or  inexperienced 
practitioner,  the  climate  or  temperature  has  a  controlling  in- 
fluence on  the  action  and  effects  of  drugs,  as  well  as  on  pathologic 
conditions,  which  fact  has  been  demonstrated  by  clinical  experience. 

The  method  and  time  of  administration  also  have  some  influence 
on  the  effects  of  drugs.     It  has  been  mentioned  elsewhere  that  the 


CLASSIFICATION    OF    MEDICINES.  27 

nearer  the  site  of  the  disease  the  remedy  is  applied  the  more  effectual 
and  safer  is  its  use.  It  is  also  true  that  the  body  is  generally  more 
resistant  in  the  morning  than  in  the  evening,  especially  in  the  case  of 
hypnotic  drugs;  thus  a  dose  of  chloral  hydrate,  for  example,  which 
may  have  little  or  no  effect  in  the  morning  when  the  brain  is  clear  and 
active,  induces  sound  sleep  when  given  in  the  evening,  because  the 
brain  now  is  already  fatigued  and  depressed. 

CLASSIFICATION  OF  MEDICINES. 

In  their  attempt  to  keep  pace  with  the  advancement  of  knowl- 
edge, writers  upon,  and  teachers  of,  Materia  Medica,  Pharmacology, 
and  Therapeutics  have  devised,  from  time  to  time,  various  systems  of 
classification  of  drugs  and  remedial  agents.  The  unsettled  state  of 
knowledge  regarding  normal  physiologic  processes  and  of  the  physio- 
logic action  of  remedies  upon  pathologic  conditions  which  they  are 
expected  to  correct,  are  sufficient  reasons,  in  the  author's  opinion,  for 
stating  that  therapeutics  is  far  from  being  an  exact  science.  At  this 
time,  therefore,  no  really  scientific  classification  of  these  substances  is 
possible.  It  is  imperative,  however,  as  an  aid  to  the  student,  that 
some  system  of  classification  be  followed,  and,  inasmuch  as  the  tend- 
ency in  modern  therapeutics  is  along  rational  lines,  i.e.,  administering 
or  applying  the  remedy  because  of  its  known  pharmacologic  action, 
a  system  of  classification  will  be  followed  by  which  drugs  will  be 
divided  into  local  and  general  remedies,  and  grouped,  so  far  as  possible, 
according  to  their  physiologic  action  and  therapeutic  application. 
It  is  important,  however,  that  the  student  familiarize  himself  at  the 
beginning  of  the  study  of  drugs  and  their  uses  with  the  definitions  of 
remedies  with  reference  to  their  action  upon  the  tissues,  organs,  and 
functions  of  the  body.  Therefore,  as  an  appropriate  introduction  to 
that  part  of  this  work  devoted  to  drugs  proper,  brief  definitions  of 
remedies,  alphabetically  arranged,  are  here  inserted,  together  with 
practical  examples  of  each. 

DEFINITIONS  OF  REMEDIES. 

Antacids. — These  are  agents  which  neutralize  acids  by  reason  of 
their  alkaline  or  basic  properties.     Examples  are: 

v  Sodium  Bicarbonate. 

Solution  of  Calcium  Hydroxid  (Lime-water). 
M;n,rnesium  Hydroxid  (Milk  of  Magnesia). 


2$  DEFINITION    OF    REMEDIES. 

Alteratives. — Agents  that  alter  or  counteract  morbid  condi- 
tions by  promoting  metabolism  or  the  processes  of  nutrition.  Exam- 
ples are:' 

Potassium  Iodid.  Arsenic. 

Mercury.  Cod-liver  Oil. 

Analgesics  or  Anodynes. — These  are  agents  which  relieve  pain 
either  by  direct  depression  of  the  centers  of  perception  and  sensation 
in  the  cerebrum  or  by  impairing  the  conductivity  of  the  sensory  nerve 
fibers/    Examples  are: 

Opium.  The  Bromids. 

Butyl-chloral  Hydrate. 

Anesthetics. — These  are  agents  which  temporarily  destroy 
sensation.  They  are  divided  into  two  classes,  local  and  general.  A 
local  anesthetic  abolishes  sensation  in  a  part,  while  a  general  anes- 
thetic abolishes  all  sensation  and  induces  unconsciousness.  Exam- 
ples are: 

Local  anesthetics.  General  anesthetics. 

Cocain   Hydrochlorid.  Nitrous  Oxid. 

Eucain  Hydrochlorid.  Chloroform. 

Ethyl  Chlorid  spray.  Ether. 

Antagonists. — These  are  agents  which  directly  oppose  each 
other  in  some  or  all  of  their  pharmacologic  actions.  Advantage  is 
taken  of  drugs  which  antagonize  each  other  in  cases  of  poisoning. 
Important  examples  are: 

Strychnin  and  Cocain.  Atropin  and  Morphin. 

Caffein  and  Cocain. 

Anthelmintics. — These  are  agents  which  destroy  (vermicides) 
or  expel  (vermifuges)  intestinal  worms.     Examples  are: 

Pepo  (Pumpkin-seed).  Oil  of  Turpentine. 

Thymol. 

Antipyretics. — These  are  drugs  or  remedies  which  reduce  the 
body  temperature  when  abnormally  high.     Examples  are: 

Aconite.  The  Coal-tar  Products: 

Quinin.  Antipyrin.  Acetanilid. 

Phenacetin. 

Antiseptics. — These  are  agents  which  inhibit  the  growth  of 
microorganisms.     Examples  are: 

Oil  of  Cloves.  Benzoic  Acid. 

Phenol  (5  per  cent,  solution).  Sodium  Borate  (Borax). 

Boric  Acid.  Glycerin, 

Alcohol  (20  per  cent,  solution).  Betanaphthol. 


DEFINITION    OF    REMEDIES.  29 

Antispasmodics. — These  are  agents  which  control  spasms  and 
lessen  states  of  general  nervousness.     Examples  are: 

Camphor.        Compound  Spirit  of  Ether  (Hoffmann's  Anodyne). 
Valerian. 

Astringents. — These  are  agents  which  contract  or  condense 
tissue.     Examples  are: 

Alum.  Zinc  Phenolsulphonate. 

Tannic  Acid.  Zinc  Iodid. 

Bismuth  Subnitrate.  Silver  Nitrate. 

Zinc  Chlorid.  Copper  Sulphate. 

Bleachers. — These  are  agents  used  to  restore  the  color  of  tooth- 
structure.     Examples  are: 

Sodium  Dioxid.  Alphozone. 

Hydrogen  Dioxid.  Chlorin. 

Sulphurous  Acid. 

Carminatives. — These  are  agents  which  promote  the  expulsion 
of  gas  from  the  stomach.     Examples  are: 

Capsicum.  Pepper. 

Mustard.  Cinnamon. 

Ginger.  Cardamom. 

Cathartics. — These  are  agents  used  to  produce  evacuation  of  the 
bowels.  Cathartic  drugs  are  classified  according  to  the  intensity  of 
their  action.  Thus  those  that  are  mild  in  action  and  produce  a  nearly 
normal  stool  are  called  laxatives.  Those  more  powerful,  usually 
producing  more  copious  stools,  are  termed  purgatives.  Those  which 
produce  a  watery  evacuation  of  the  bowels  are  called  hydragogues. 
Those  which  gripe,  having  a  violent  action,  are  called  drastics. 
Examples  of  each  class  follow: 

Laxatives.  Purgatives. 

Tamarind.  Aloes. 

Cascara  Sagrada.  Senna. 

Manna.  Castor  Oil. 

Honey.  Calomel. 

Figs.  Rhubarb. 

Prunes.  Blue  Mass. 

Hydragogues.  Drastics. 

Magnesium  Sulphate.  Croton  Oil. 

Sodium  Sulphate.  Colocynth. 

Potassium  and  Gamboge. 

Sodium  Tartrate  (Rochelle  Salt).  Jalap. 

Sodium  Phosphate.  Podophyllum. 

Magnesium  Citrate. 


30  DEFINITION    OF    REMEDIES. 

Demulcents. — These  are  substances  largely  of  a  mucilaginous 
nature,  which  soothe  and  protect  the  parts  to  which  they  are  applied. 
Examples  are: 

Acacia.  Marshmallow. 

Licorice.  Starch. 

Sassafras  Pith.  Flaxseed. 

Slippery  Elm.  White  of  Egg. 

Dentifrices. — These  are  medicated  powders  or  pastes  applied 
with  a  suitable  brush  to  cleanse  the  teeth  and  gums.  Precipitated 
chalk  (calcium  carbonate)  is  the  base  of  all  dentifrices.  For  examples 
see  Practical  Therapeutics,  p.  252. 

Deodorants. — These  are  agents  which  destroy  offensive  odors. 
Examples  are: 

Formaldehyd.  Potassium  Permanganate. 

Chlorin  Gas.  Charcoal. 

Hydrogen  Dioxid.  Sulphurous  Acid. 

Diaphoretics  or  Sudorifics. — These  are  agents  which  promote 
the  secretion  of  sweat.  When  the  action  of  the  remedy  is  such  that 
the  perspiration  stands  in  beads  upon  the  purface,  it  is  called  sudorific. 
Examples  are: 

Pilocarpus  (Pilocarpin).  Ammonium  Acetate. 

Dover's  Powder.  Spirit  of  Nitrous  Ether. 

Disinfectants  or  Germicides. — These  are  agents  which  destroy 
microorganisms  and  their  spores.     Examples  are: 

Mercuric  Chlorid.  Urotropin. 

Formaldehyd.  Hydrogen  Dioxid. 

Cresol.  Potassium  Permanganate. 

Phenol.  Silver  Compounds. 

Thymol.  Betanaphthol. 

Heat.  Chlorin  Gas. 

Diuretics. — These  are  agents  which  increase  the  flow  of  urine. 
Examples  are: 

Potassium  Salts.  Effervescent  Salts. 

Lithium  Salts.  Spirit  of  Nitrous  Ether  (Sweet 

Spirit  of  Niter). 

Emetics. — These  are  agents  which  produce  vomiting.  Exam- 
ples are: 

Ipecac.  Alum. 

Tartar  Emetic.  Mustard. 

Zinc  Sulphate.  Apomorphin. 

Copper  Sulphate.  Tepid  Water,  in  quantity. 


DEFINITION    OF    REMEDIES.  31 

Emollients. — These  are  substances  which  protect,  soften,  and 
relax  the  tissues  to  which  they  are  applied.     Examples  are: 

Hot  Fomentations.  ,    Linseed  Oil. 

Poultices.  Petroleum. 

Lard.  Cacao  Butter. 

Lanolin.  Glycerin. 

Olive  Oil.  Almond  Oil. 

Escharotics  or  Caustics. — These  are  agents  which  destroy  the 
tissues  upon  which  they  act.     Examples  are: 

Mineral  Acids.  Osmic  Acid. 

Caustic  Alkalies.  Zinc  Chlorid. 

Phenol.  Sodium  Ethylate. 

Arsenic  Trioxid.  Mercuric  Chlorid. 

Trichloracetic  Arid.  Silver  Nitrate. 

Actual  Cautery. 

Expectorants. — These  are  agents  which  modify  the  secretion 
of  mucus  from  the  mucous  membrane  of  the  air-passages  and  facilitate 
its  expulsion.     Examples  are: 

Ammonium  Chlorid.  Squill. 

Eucalyptus.  Ipecacuanha. 

Potassium  Citrate. 

Hypnotics  or  Somnifacients. — These  are  agents  which  produce 
sleep.     Examples  are: 

Chloral  Hydrate.  Trional. 

Butyl-chloral  Hydrate.  Paraldehyd. 

Sulphonal.  The  Bromids. 

Opium  (and  Alkaloids). 

Irritants. — These  are  agents  which,  when  applied  to  the  skin  or 
mucous  membrane  of  the  mouth,  cause  active  hyperemia  or  inflam- 
mation. When  they  are  applied  not  simply  for  their  local  action, 
but  to  influence  favorably  a  deep-seated  part  which  is  diseased,  they 
are  called  counter-irritants.  Irritants  are  largely  used  for  the 
latter  purpose  in  dental  practice.     Examples  are: 

Iodin.  Aconite. 

Mustard.  Chloroform. 

Capsicum.  Volatile  Oils. 

Camphor.  Menthol. 

Mydriatics. — These  are  agents  which  produce  dilatation  of  the 
pupil  of  the  eye.     Examples  are: 

Atropin.  Homatropin. 

Hyoscyamin.  Cocain. 

Anesthetics  (late  in  their  action). 


32  DEFINITION    OF    REMEDIES. 

Myotics. — These  are  agents  which  produce  contraction  of  the 
pupil  of  the  eye.     Examples  are: 

Physostigma,    Eserin.  Anesthetics    (early    in    their 

Opium,  Morphin.  action). 

Narcotics. — These  are  agents  which  produce  stupor.  Exam- 
ples are: 

Opium  (and  Alkaloids).  Chloroform. 

Alcohol.  Ether. 

Restoratives. — These  are  agents,  somewhat  similar  to  altera- 
tives, which  promote  constructive  metamorphosis.  Restoratives 
include: 

FOODS,  HEMATICS,  AND  TONICS. 

Foods  are  substances  which,  when  introduced  into  the  body, 
supply  material  to  renew  some  structure  or  to  maintain  some  vital 
process.  They  differ  from  medicines  in  that  the  latter  modify  vital 
processes,  but  furnish  no  material  to  sustain  such. 

Hematics  are  medicines  which  increase  the  hematin  in  the 
blood,  and  enrich  the  red  blood-corpuscles.  The  compounds  of 
iron  are  the  principal  hematics. 

.Tonics  are  agents  which  improve  the  tone  and  give  strength  and 
energy  to  the  tissues.     Among  the  tonics  are: 

Iron  and  Compounds.  Cod-liver  Oil. 

Phosphorus.  Nux  Vomica. 

Calcium  Phosphate.  Cinchona. 

Hypophosphites.  Arsenic. 

Sedatives. — These  are  agents  which  exert  a  soothing  influence 
on  the  system  by  lessening  functional  activity  and  diminishing  pain. 
They  have  been  largely  considered  in  other  classes  of  remedies,  as: 
General  sedatives  include  anesthetics  and  narcotics.  Nervous  seda- 
tives include  the  bromids,  tobacco,  etc. 

Sialogogues. — These  are  agents  which  stimulate  the  salivary 
and  buccal  mucous  glands,  increasing  the  secretion  and  flow  of  saliva 
and  buccal  mucus.  Holding  the  mouth  open,  as  in  dental  operations, 
changes  the  character  and  flow  of  the  mouth  secretions.  Examples 
of  drugs  producing  this  effect  are: 

Pilocarpus  (Jaborandi).  Iodin  Compounds. 

Mercurials.  Tobacco. 

Echinacea,  Echafolta.  Potassium  Chlorate. 


hi   I'lXITlON     <»K     KI.MI.DII.S. 


33 


Stimulants.-  These  arc  agents  which  increase  the  activity  of 
an  organic  function  or  process.  When  applied  to  medicinal  agents 
the  term  is  used  in  various  senses,  for  different  agents  stimulate  the 
functional  activity  of  the  various  organs  of  the  body.  As  examples 
w  e  have: 


Cnrilitic. 

Respiratory. 

Gastric. 

Restorative 

Strychnin. 

Atropin. 

Gentian. 

Normal  Saline  Solution 

Digitalis. 

Bitter  Tonics. 

CaiTein. 

Alcohol. 

Styptics  and  Hemostatics.-  These  are  agents  which  arrest 
hemorrhage.  When  the  agent  is  applied  locally  it  is  called  a  Styptic; 
when  administered  internally  it  is  called  a  Hemostatic.  Examples 
are: 


Styptics. 

Acids. 

Alum. 

Ferric  Subsulphate. 

Adrenalin  Chlorid. 

Cauterization. 


Hemostatics. 
Ergot. 
Gallic  Acid. 
Hamamelis. 


34 


DRUGS. 


DRUGS. 

As  stated  elsewhere,  an 'effort  will  be  made  to  divide  drugs  into 
local  and  general  remedies,  and  group  them,  so  far  as  possible,  accord- 
ing to  their  physiologic  action  and  therapeutic  application.  Those 
drugs  which  are  largely  applied  locally  in  dental  practice  will  first  be 
considered. 

LOCAL  REMEDIES. 

ANTACIDS. 

Antacids  are  agents  which  neutralize  acids  by  virtue  of  their 
alkaline  or  basic  property.  All  acids,  whether  mineral  or  organic,  have 
a  destructive  action  on  the  tooth-structure.  Acids  are  found  in  the 
mouth  as  a  result  of  the  fermentation  of  carbohydrate  food-stuffs, 
from  eructations  of  the  stomach,  and  from  perverted  buccal  mucous 
glands.  Agents  which  are  capable  of  neutralizing  acids,  therefore, 
have  an  important  role  to  play  in  the  broad  field  of  oral  prophylaxis. 
They  should  form  the  base  of  all  dentifrices  and  enter  as  an  essential 
constituent  into  nearly  all  mouth-washes.  The  most  important 
antacids  are:  , 

Calcium  Carbonate.  Sodium  Borate  (Borax). 

Lime-water.  Magnesium  Oxid. 

Sodium  Bicarbonate.  Soap. 

CALCII   CARBONAS— U.  S.  P. 

(Calcium  Carbonate;  Chalk;  CaC03.) 

There  are.  two  official  forms  of  chalk:  Precipitated  calcium  car- 
bonate and  prepared  chalk.  The  former  is  made  by  mixing  aqueous 
solutions  of  calcium  chlorid  and  sodium  carbonate,  the  resulting 
precipitate  of  calcium  carbonate  being  purified.  The  latter  is  native 
calcium  carbonate,  freed  from  most  impurities  by  elutriation  (washing). 
Both  forms  occur  as  a  white,  amorphous  powder,  odorless  and  tasteless, 
and  permanent  in  the  air,  nearly  insoluble  in  water  and  insoluble  in 
alcohol. 

Therapeutics. — Chalk  is  an  antacid  and  mild  astringent.  It  is 
an  excellent  antacid  when  the  acidity  of  the  fluids  of  the  mouth  are  due 
to  eructations  from  the  stomach.  It  may  be  prescribed  as  an  antidote 
in  general  poisoning  by  any  of  the  mineral  acids  or  by  oxalic  acid, 


LIQUOR    CALCIS — SODII    BICARBONAS.  35 

care  being  taken  to  avoid  the  rapid  evolution  of  large  quantities  of 
gas  (C02).  Because  of  its  antacid  properties  and  its  almost  insolu- 
bility, it  enters  into  the  composition  of  nearly  all  dentifrices,  forming 
the  base  of  most  tooth-powders  and  pastes. 

LIQUOR  CALCIS  — U.  S.  P. 
(Solution  of  Calcium  Hydroxid;  Lime-water;  Ca(OH)2.) 

Lime-water  is  a  saturated  solution  of  pure  calcium  hydroxid  in 
water.  The  liquid  should  be  clear  and  colorless,  without  odor,  and 
having  a  saline  and  feebly  caustic  taste.  It  should  contain  not  less 
than  o.  14  per  cent,  of  calcium  hydroxid.  When  administered  internally 
the  dose  is  from  1/2-2  fl.  oz.  (15.0-60.0  c.c).  A  useful  official 
preparation  is  linimentum  calcis  (equal  volumes  of  lime-water  and 
linseed  oil). 

Therapeutics. — All  cases  where  cows'  milk  is  the  chief  article  of 
diet,  as  in  the  artificial  feeding  of  children,  lime-water  should  be  added 
to  the  milk  to  prevent  the  formation  of  hard  curds  in  the  stomach. 
In  cases  of  obstinate  vomiting,  as  in  pregnancy,  when  the  vomiting  or 
eructations  are  due  to  a  high  degree  of  acidity,  it  is  a  useful  remedy.  In 
chronic  catarrh  with  an  excessive  secretion  of  mucus,  lime-water  diluted 
with  two-thirds  cinnamon  water,  to  which  a  small  amount  of  alcohol 
is  added,  can  be  used  as  a  spray  and  for  rinsing  the  mouth  and  brushing 
the  teeth,  gums,  and  tongue  with  gratifying  results.  The  official 
liniment,  called  also  Carron  Oil,  is  employed  as  a  soothing  application 
for  burns  and  scalds. 

SODII  BICARBONAS— U.  S.  V. 

(Sodium  Bicarbonate;  XaHC03.) 

Sodium  bicarbonate  is  a  white,  opaque  powder,  without  odor, 
and  having  a  cooling  and  slightly  alkaline  taste.  It  is  freely  soluble 
(12  parts)  in  water  and  insoluble  in  alcohol.  The  dose  is  from  5-30  gr. 
(0.3-2.0  gm).     An  important  official  preparation  is: 

Trochisci  Sodii  Bicarbonatis,  (containing  2  1/2  gr.  (0.18  gm.) 
each). 

Therapeutics. — Sodium  bicarbonate  is  extensively  used  to 
neutralize  the  excess  of  hydrochloric  acid  or  abnormal  acids  in  the 
stomach.  Given  in  the  form  of  a  troche  an  hour  or  two  before  meals, 
it  allays  the  burning  pain,  eructations,  and  palpitations  caused  by  the 
acids  of  fermentation. 

Sodium  bicarbonate  is  often  applied  externally  as  a  sedative 
dressing  for  superficial    burns.     A  5  to  10  per  cent,  solution  has  been 


36  ANTACIDS. 

used  in  cases  of  thrush  with  excellent  results.  It  is  an  ingredient  of 
the  popular  Dobell's  solution  (see  page  130)  and  used  as  an  antacid  or 
detergent -in  many  mouth- washes.  Sodium  bicarbonate  is  added  to 
the  water  in  which  instruments  are  boiled  for  sterilization  to  prevent 
the  latter  from  rusting.  Sodium  carbonate  and  borax  are  also  used 
for  this  purpose.  When  acids  are  employed  in  root-canals,  they  should 
subsequently  be  neutralized  with  some  antacid,  and  nothing  is  better 
than  a  solution  of  sodium  bicarbonate.  The  powder  is  used  by  direct 
application  to  lessen  the  hypersensitiveness  of  dentin  when  due  to 
acidity.  In  the  treatment  of  pyorrhea  and  oral  prophylaxis,  the  teeth, 
oftentimes  after  the  scaling  and  polishing,  are  extremely  responsive  to 
thermal  changes,  especially  where  the  gums  have  receded,  exposing 
the  cementum.  This  can  be  controlled  by  warm  solutions  of  the  drug. 
Incompatibilities. —Sodium  bicarbonate  is  incompatible  with 
acids,  metallic  salts,  and  alkaloids. 

SODII  BORAS— U.  S.  P. 

(Sodium  Borate;  Sodium  Eiborate;  Borax;  Na2B407.ioH20.) 

Borax  occurs  in  colorless  crystals  or  white  powder,  inodorous,  and 
of  a  sweetish  alkaline  taste.  It  is  soluble  in  about  16  parts  of  water 
and  1  part  of  glycerin,  and  is  insoluble  in  alcohol.  The  dose  is  from 
5-20  gr.  (0.3-1.3  gm.).  An  official  preparation  for  external  use  con- 
taining borax  is: 

Unguentum  Aquae  Rosae  (Cold  Cream). 

Therapeutics. — The  alkaline  and  antiseptic  properties  of  borax 
make  it  a  useful  drug.  It  is  a  valuable  ingredient  in  mouth-washes 
possessing  the  above  qualities,  and  can  be  used  freely  in  saturated 
solution  (6  1/4  per  cent.)  in  cases  of  stomatitis  and  in  thrush.  In  the 
latter  disease,  which  generally  occurs  in  the  mouths  of  infants  where' 
it  is  impracticable  to  use  a  mouth-wash  to  advantage,  a  saturated 
solution  in  glycerin,  made  by  dissolving  the  drug  in  hot  glycerin,  can 
be  employed.  This  thick,  sweet  solution  should  be  applied  by  means 
of  a  swab  to  the  mucous  membranes  of  the  infant's  mouth.  A  satu- 
rated solution  in  a  10  per  cent,  formaldehyd  solution  makes  an  ex- 
cellent sterilizing  fluid  for  small  instruments.  The  borax  prevents  the 
formaldehyd  from  attacking  the  metal.  A  good  collyrium  (eye-water) 
can  be  made  by  adding  2  per  cent,  of  borax  to  a  saturated  solution 
of  boric  acid. 

Incompatibilities. — Borax  is  incompatible  with  acids,  metallic 
salts,  and  alkaloids,  and  glycerin  slowly  converts  it  into  boric  acid. 


MAGNESII  OXIDUM — SAPO.  37 

MAGNESII  OXIDUM—  U.  S.  P. 
(Magnesium  Oxid;   Light  Magnesia;  Calcined  Magnesia;  MgO.) 

Light  magnesia  is  a  very  light,  white,  odorless  powder,  having 
an  earthy-like  taste.     It  is  practically  insoluble  in  water,  and  insoluble 
in  alcohol,  but  chemically  soluble  in  dilute  acids.     The  dose  is  from 
30-00  gr.    (2.0-4.0  gm.).     An   important  official  preparation  is: 
Ferri-hydroxidum  cum  Magnesii  Oxido. 

Therapeutics. — Magnesia  is  partly  converted  by  the  acids  of 
the  stomach  into  soluble  salts  that  act  as  laxative's;  hence,  when  inter- 
nally administered,  the  antacid  properties  of  magnesia  are  combined 
with  those  of  a  mild  aperient  or  laxative.  The  preparation  of  ferric 
hydrate  with  magnesia  has  long  been  recognized  as  an  efficient  anti- 
dote in  arsenical  poisoning.  Other  compounds  of  magnesia,  recog- 
nized by  the  U.  S.  P.  are  heavy  magnesia  (magnesia  oxid — 3  1/2 
times  as  heavy  as  light  magnesia)  and  magnesium  carbonate.  Both 
have  practically  the  same  properties  and  uses  as  light  magnesia. 
Magnesium  carbonate,  however,  should  be  used  cautiously  when 
there  is  much  acid  in  the  stomach  on  account  of  the  unpleasant  eruc- 
tations of  gas  (C02).  Magnesium  carbonate,  being  cheap  and  in- 
soluble, is  often  substituted  for  talc  or  precipitated  calcium  phosphate 
in  the  preparation  of  the  medicated  wraters.  The  suspended  pre- 
cipitate of  magnesium  hydrate,  commercially  called  milk  of  magnesia, 
is  a  useful  antacid.  In  cases  of  erosion  of  the  teeth,  in  pregnancy, 
and  other  conditions  wherein  the  mouth  secretions  are  acid  in  reaction, 
it  can  be  used  to  advantage  by  coating  the  exposed  tooth-surfaces 
with  it.  Its  gelatinous  consistence  causes  it  to  adhere  and  remain 
for  a  considerable  length  of  time,  especially  if  applied  on  retiring  at 
night  when  the  jaws  and  buccal  tissues  are  at  rest. 

SAPO— U.  S.  P. 

(Soap;  White  Castile  Soap.) 

The  only  official  soap  is  white  castile  soap,  made  by  boiling  olive 
oil  with  sodium  hydroxid.  Any  fat  boiled  with  sodium  or  potassium 
hydroxid  will  form  soap.  Hard  soap  is  a  sodium  soap,  soft  soap  is  a 
potassium  soap.  White  castile  soap  should  be  hard,  but  easily  cut 
when  fresh,  and  easily  pulverized  when  dry,  and  free  from  rancid  odor. 
It  has  a  rather  unpleasant  taste  and  an  alkaline  reaction,  hence  it 
is  an  antacid,  soluble  in  water  and  in  alcohol. 

A  useful  preparation  is: 

Linimentum  Saponis  Mollis — U.  S.  P.  (Liniment  of  Soft  Soap, 
Tincture  of  Green  Soap.) 


38  ANTISEPTICS,    DISINFECTANTS   AND    DEODORANTS. 

Therapeutics. — White  castile  soap  is  alkaline  in  reaction  and 
somewhat  antiseptic,  possessing  detergent  properties  to  a  marked 
degree.  The  greatest  value  of  soap  lies  in  its  power  to  dissolve  fats. 
Advantage  is  taken  of  this  fact  in  bleaching  teeth  as  will  be  explained 
in  Practical  Therapeutics  (page  332).  White  castile  soap  is  chiefly 
used  in  dental  practice  as  a  constituent  of  dentrifices,  both  tooth- 
powders  and  tooth-pastes.  The  preparation  should  not  contain  more 
than  about  25  per  cent.;  for,  in  greater  quantities,  too  much  suds  is 
formed  in  the  mouth  by  its  employment.  The  preparation  known 
as  tincture  of  green  soap  is  a  valuable  toilet  article  for  dentist's  hands. 

Incompatibilities. — Soap  is  incompatible  with  all  acids  and 
with  earthy  and  metallic  salts.  It  is  precipitated  in  hard  water  (con- 
taining earthy  salts)  as  an  insoluble  soap. 

ANTISEPTICS,  DISINFECTANTS,  AND  DEODORANTS. 

The  term  antiseptic  has  been  defined  elsewhere  as  applying  to  that 
class  of  remedies  which  inhibit  or  have  a  restraining  influence  on  the 
life  and  activity  of  microorganisms.  The  terms  disinfectant  and 
germicide  have  been  previously  referred  to  as  applying  to  that  class  of 
remedies  which  destroy  microorganisms  and  their  spores.  Some 
authors  have  endeavored  to  distinguish  between  the  two  latter  terms, 
using  the  term  germicide  in  the  sense  that  the  agent  simply  kills  the  germ, 
and  disinfectant  in  the  sense  that  the  agent  not  only  kills  the  germ, 
but  also  acts  upon  the  noxious  products  of  putrefaction  and  fermenta- 
tion. As  a  matter  of  fact,  this  distinction  is  largely  theoretical,  for  there 
are  few  agents  which,  if  used  in  sufficient  strength  to  kill  the  germ,  will 
not  also  act  upon  and  thus'  destroy  or  remove  the  by-products  of  germ- 
growth.  In  this  work,  therefore,  the  term  disinfectant  will  be  used  in 
preference  to  the  term  germicide,  and  for  the  reason  given.  A  deodor- 
ant is  an  agent  which  destroys  offensive  odors,  and  inasmuch  as  the 
odor  generally  comes  from  the  noxious  products  of  putrefaction,  the 
deodorization  results  from  true  disinfection.  Therefore,  deodorants 
will  be  discussed  conjointly  with  antiseptics  and  disinfectants. 

Many  agents  belong  to  both  the  antiseptic  and  disinfectant 
classes  of  remedies,  depending  upon  the  strength  in  which  they  are 
employed.  In  weak  solutions  they  act  as  antiseptics;  in  strong  solu- 
tions, as  disinfectants.  These  two  classes  of  remedies  are  among  the 
most  important  classes  employed  in  dental  practice,  and  it  is  well 
that  the  student  should  understand  at  the  outset  the  significance  of 
these  remedies. 


EXAMPLES    OF   ANTISEPTICS.  39 

In  all  surgical  work  the  ideal  condition  sought  is  the  absence  of 
disease-producing  germs  (asepsis),  rather  than  to  depend  upon  the 
chemic  destruction  of  them  at  the  time  of  operating.  With  this  end 
in  view,  the  instruments  are  sterilized  by  boiling,  and  the  site  of  opera- 
tion as  well  as  the  operator's  hands  are  disinfected  by  washing  in 
certain  solutions.  Strictly  speaking,  infected  animal  tissue  cannot  be 
sterilized  by  employing  disinfectants.  An  ideal  disinfectant  would-be 
an  agent  which,  employed  in  certain  strength  solution  in  a  septic  process 
or  disease,  would  kill  the  disease-producing  germ  and  destroy  or  remove 
the  poisonous  by-products  without  acting  deleteriously  upon  the  animal 
cell.  But  bacteriologists  inform  us  that  the  cell-wall  of  a  vegetable 
cell  (bacteria)  is  less  permeable  to  disinfecting  agents  than  is  the  cell- 
wall  of  the  animal  cell.  Therefore,  in  our  present  state  of  knowledge 
we  should  not  employ  disinfectants  in  our  effort  to  kill  the  germ  when 
its  habitat  is  among  living  animal  cells.  It  becomes  necessary,  then,  to 
attack  these  germs  in  another  manner.  This  can  be  done  by  the  use  of 
certain  antiseptic  agents  which  check  the  growth  and  activity  of  the 
germs,  cripple  them  as  it  were,  and  which  agents  also  are  just  suffi- 
ciently irritating  to  the  animal  cells  as  to  produce  stimulation.  This 
stimulating  or  awakening  process  on  the  part  of  the  animal  cells  will 
cause  the  latter  to  attack  and  destroy  the  already  crippled  vegetable 
cells,  thus  bringing  about  nature's  method  of  sterilization. 

When  the  germs  which  we  are  endeavoring  to  destroy  are  among 
the  contents  of  a  putrescent  root-canal,  for  example,  surrounded  by 
hard  tooth-structure  and  removed  from  live  animal  tissue,  the  problem 
presents  an  entirely  different  aspect.  Here  true  disinfectants  can  be 
efmployed.  Because,  then,  a  remedy  will  destroy  microorganic  life  in  a 
certain  length  of  time  in  a  test-tube,  or  in  a  putrescent  root-canal,  is  no 
criterion  that  the  remedy,  as  such,  can  be  used  for  disinfecting  the  soft 
tissues  of  the  mouth. 

The  chief  antiseptics  are: 

Boric  Acid.  Many  Volatile  Oils: 

Borax.  Oil  of  Cajuput. 

Benzoic  Acid.  Oil  of  Cinnamon. 

Salicylic  Acid.  Oil  of  Cloves. 

Salol.  Oil  of  Eucalyptus. 

Salophen.  Oil  of  Peppermint. 

Sodium  Salicylate.  Oil  of  Thyme. 

Iodin  and  Compounds.  Charcoal. 

Beta  Naphthol.  Calendula. 

Resorcin.  Arnica. 

Silver  Compounds.*  Myrrh. 

Ozone  and  Oxygen. 


40  ANTISEPTICS,    DISINFECTANTS    AND    DEODORANTS. 

The  chief  disinfectants  are: 

Mercuric  Chic-rid  (Discussed  Urotropin. 

under  Mercury  in  Alteratives).  Hydrogen  Dioxid. 

Phenol.  Potassium  Permanganate. 

Cresols.  Chinosol. 

Creasote.  Kresamin. 

Formaldehvd.  Heat. 


ACIDUM  BORICUM— U.  S.  P. 

(Boric  Acid;  Boracic  Acid;  H3B03.) 

Boric  acid  occurs  in  transparent,  colorless,  pearly  scales  or 
crystals,  nearly  colorless  and  of  a  somewhat  bitterish  taste,  and  slightly 
unctuous  to  the  touch.  It  is  soluble  in  about  25  parts  of  water,  15  parts 
of  alcohol,  and  10  parts  of  glycerin.  When  given  internally  the  dose 
is  from  5  to  20  gr.  (0.3-1.3  gm.) 

All  of  the  official  preparations  are  valuable,  in  dental  practice. 
They  are: 

Liquor  antisepticus,  Antiseptic  Solution,  (contains  2  per  cent. 

of  boric  acid,  0.1  per  cent,  each  of  benzoic  acid  and  thymol, 

25  per  cent,  of  alcohol,  and  minute  quantities  of  eucalyptol, 

oil  of  peppermint,  oil  of  gaultheria,  and  oil  of  thyme,  in  "an 

aqueous  vehicle). 

Glyceritum  boroglycerini,  Glycerite  of  Boroglycerin,  (contains 

31  per  cent,  of  boric  acid  in  glycerin). 

Unguentum  acidi  borici,  Ointment  of  Boric  Acid  (10  per  cent.). 

Physiologic  Action. — In  quantities  generally  employed  by 
dentists,  boric  acid  produces  no  appreciable  symptoms.  It  is  rapidly 
absorbed  and  rapidly  eliminated  by  the  saliva,  perspiration,  feces,  and 
urine — -the  bulk  of  it  escaping  in  the  urine  .within  twenty-four  hours 
after  its  administration.  It  is  not  a  drug  to  be  used  indiscriminately,  for 
repeated  external  applications  have  led  to  the  same  train  of  symptoms 
as  those  observed  following  the  continued  internal  administration  of  the 
drug.  The  term  borism  has  been  applied  to  this  condition,  and  the 
most  important  phenomena  are  digestive  disturbances,  dryness  of  the" 
skin  and  mucous  membranes,  and  a  tendency  toward  certain  rashes. 
The  drug  has  been  used  as  a  preservative  of  milk  and  foods,  and  there 
is  a  difference  of  opinion  among  investigators  as  to  whether  or  not 
boric  acid  has  a  deleterious  action  when  so  used. 

Therapeutics. — Boric  acid  is  a  constituent  of  many  mouth- 
washes. It  is  largely  employed  in  a  saturated  aqueous  solution 
(4  per  cent.)  as  an  antiseptic  and  stimulating  wash.     Because  of  its 


S0DI1    BOBAS      ACIDUM    HI  N/mK'UM.  41 

nonirritating  properties  it  can  be  applied  to  the  most  sensitive  tissue. 
A  good  collyrium  (eye-wash)  can  be  made  by  adding  10  gr.  (o.6»m.) 
of  borax  to  1  fl.  oz.  (30.0  c.c.)  of  the  saturated  solution  of  boric  acid. 
Lotions,  ointment,  and  dusting-powders  containing  boric  acid  are  used 
to  advantage  in  many  acute  inflammatory  conditions  of  the  mucous 
membranes  and' skin.  As  a  stimulating  and  antiseptic  mouth-wash 
there  is  none  better  than  the  official  liquor  antisepticus. 

Probably  the  only  objection  to  boric  acid  as  a  constituent  of 
mouth-washes  is  its  slightly  acid  reaction  and  rather  sparing  solubility 
in  water.  Whenever  a  stronger  solution  than  the  saturated  is  desired, 
the  official  glyceritum  boroglycerini  (glycerite  of  boroglycerin)  can  be 
used.  This  is  neutral  in  reaction  and  can  be  employed  in  full  strength 
or  diluted.  However,  strong  solutions  should  not  be  used  continu- 
ously on  account  of  the  tendency  to  produce  borism. 

Incompatibilities.— In  aqueous  solution  it  will  decompose  car- 
bonates and  bicarbonates. 

SODII  BORAS— U.  S.  P. 

Borax. — This  salt  has  been  fully  discussed  under  Antacids  (see 
p.  36).  Its  antiseptic  and  alkaline  properties  give  it  a  prominent 
place  among  dental  remedies.  The  physiologic  action  of  borax  closely 
resembles  that  of  boric  acid,  for  which  it  is  often  substituted  to  good 
advantage,  especially  in  mouth-washes  where  it  is  desired  to  have  an 
alkaline  solution,  and  in  tooth-powders  and  pastes.  Boric  acid,  as 
well  as  all  other  acids,  is  incompatible  with  carbonates,  and  as  calcium 
carbonate  (chalk)  is  the  base  of  nearly  all  dentifrices;  boric  acid  should 
not  be  a  constituent.  Here  the  sodium  salt,  borax,  can  be  employed 
with  the  same  result  without  any  reaction  (incompatibility)  between  the 
ingredients  of  the  mixture. 

ACIDUM  BEJVZOICUM— U.  S.  P. 
(Benzoic  Acid;  HC.H502.) 

Benzoic  acid  is  an  organic  acid  obtained  from  benzoin  and 
balsam  of  Peru,  or  prepared  artificially  from  toluene,  a  coal-tar  deriva- 
tive. It  occurs  in  white  or  slightly  yellow  scales  or  needle-shaped 
crystals  of  an  aromatic  odor  and  taste.  It  is  sparingly  soluble  in 
water,  but  with  an  equal  quantity  of  borax  it  can  be  dissolved  to  the 
extent  of  1  per  cent. ;  freely  soluble  in  alcohol  and  glycerin.  The  dose 
is  from  5  to  20  gr.  (0.3-1.3  gm.). 


42  ANTISEPTICS,    DISINFECTANTS   AND    DEODORANTS. 

Physiologic  Action. — Benzoic  acid  has  proven  to  be  an  antiseptic 
of  considerable  power.  Long  states  that  a  solution  of  1:400  has  been 
found  to  destroy  developed  bacteria.  It  also  acts  as  a  stimulant  to 
mucous  membranes.  Internally  administered  it  increases,  to  a 
variable  degree,  the  nitrogenous  output  and  lessens  the  quantity  of 
ethereal  sulphates  and  indicin  in  the  urine.  In  large  doses  benzoic 
acid  and  benzoates  have  an  irritant  action  on  the  stomach,  and  in  con- 
sequence excite  nausea  and  vomiting  (Stevens). 

Therapeutics. —  It  is  found  that  a  saturated  solution  of  borax 
(6  1  /4  per  cent.)  will  dissolve  1  per  cent,  of  benzoic  acid  and  still  be 
alkaline.  This  is  doubtless  due  to  a  reaction  between  the  substances 
whereby  sodium  benzoate  is  formed,  which  is  freely  soluble.  In  this 
way  it  may  be  employed  as  a  constituent  of  mouth-washes.  It  pos- 
sesses no  advantage  over  the  sodium  salt  which  had  better  be  employed 
direct.  Sodium  benzoate  is  an  excellent  constituent  of  dentifrices. 
In  the  form  of  the  benzoates  it  has  been  recommended  in  rheumatism 
or  the  gouty  diathesis,  but  is  not  so  efficacious  as  the  salicylates. 
Balsam  of  Peru,  which  contains  benzoic  acid,  is  used  externally  as  a 
parasiticide  in  scabes  (itch). 

Incompatibility. — Benzoic  acid  in  the  presence  of  moisture 
will  react  upon  carbonates  and  bicarbonates.  It  should  not  be  em- 
ployed, therefore,  as  a  constituent  of  dentifrices. 

ACIDUM  SALICYLICUM— U.  S.  P. 

(Salicylic  Acid;  HC7H503) 

Salicylic  acid  is  an  organic  acid  obtained  from  various  plants, 
especially  from  gaultheria  (wintergreen),  but  it  is  chiefly  prepared 
artificially  from  phenol  by  acting  upon  the  latter  with  caustic  soda 
and  carbon  dioxid.  It  occurs  as  a  white  crystalline  powder  or  in  fine 
needle-shaped  crystals,  odorless,  but  possessing  a  sweetish,  acrid  taste. 
It  is  soluble  in  about  308  parts  of  water,  2  parts  of  alcohol,  and  60  parts 
of  glycerin.     The  dose  is  from  5-20  gr.  (0.3-1.3  gm.). 

Physiologic  Action.— Salicylic  acid,  like  many  other  drugs,  acts 
differently  upon  different  individuals  and  upon  the  same  individual 
at  different  times.  In  susceptible  subjects  even  small  doses  give  rise 
to  a  peculiar  feeling  of  fullness  in  the  head,  ringing  in  the  ears,  and, 
at  times,  it  interferes  with  the  senses  of  hearing  and  sight,  causing 
deafness  and  dimness  of  vision.  It  enters  the  circulatory  fluids  as 
an  alkaline  salicylate,  and  is  eliminated  from  the  body  in  most  of  the 


I'HENYLIS    SALICYLAS.  43 

secretions,  but  principally  in  the  urine.  It  is  claimed  on  good  author- 
ity that  it  increases  the  output  of  urea  and  uric  acid. 

Therapeutics. — This  drug  must  be  classed  with  our  best  anti- 
septics. Miller  has  shown  that  a  i  per  cent,  solution  of  salicylic  acid 
will  disinfect  the  mouth,  as  ordinarily  considered,  in  one-quarter  of  a 
minute.  It  must"  not  be  forgotten,  however,  that  the  mouth  cannot  be 
disinfected  in  the  true  sense  of  the  term.  Its  sparing  solubility  in 
water  and  its  acid  character  render  it  practically  useless  as  a  constitu- 
ent of  mouth-washes,  unless  a  salt,  like  borax,  or  alcohol  be  added 
to  the  solution.  The  chief  use  of  salicylic  acid  and  its  compounds 
is  in  acute  rheumatism,  in  which  condition  they  are  considered  specific 
remedies.  In  some  diseases,  as  certain  kinds  of  pyorrhea  alveolaris, 
which  seem  to  be  related  to  the  rheumatic  diathesis,  salicylic  com- 
pounds have  proven  to  be  efficacious.  Dissolved  in  collodion,  a 
dram  (4.0  gm.)  to  the  ounce  (30.0  c.c),  it  has  long  been  used  with 
success  in  removing  corns  and  warts. 

Incompatibilities. — Salicylic  acid  will  react  with  carbonates, 
potassium  chlorate,  and  potassium  permanganate. 

PHENYLIS  SALICYLAS— U.  S.  P. 
(Phenyl  Salicylate;  Salol;  C6H5C7Hs03.) 

Salol  is  prepared  by  heating  salicylic  acid  with  phenol  in  the 
presence  of  phosphorus  pentachlorid.  It  occurs  as  a  white  crystalline 
powder,  of  a  faintly  aromatic  odor,  and  slightly  sweetish  taste,  prac- 
tically insoluble  in  water,  soluble  in  alcohol,  and  freely  so  in  ether, 
chloroform,  and  in  fixed  and  volatile  oils.  The  dose  is  from  5  to  15  gr. 
(0.3-1.0  gm.). 

Physiologic  Action. — Salol  acts  as  an  antiseptic  like  either  of 
its  constituents,  salicylic  acid  and  phenol.  It  is  not  a  disinfectant,  as 
it  will  not  destroy  bacteria,  although  it  prevents  their  proliferation. 
It  differs  from  salicylic  acid  in  its  action  in  that  it  is  not  irritating  to 
the  mucous  membrane.  Salol  resists  to  a  great  extent  the  action  of 
the  gastric  juice,  passing  through  the  stomach  practically  unchanged, 
but  is  gradually  broken  up  in  the  intestine  by  the  alkaline  fluids  into 
salicylic  acid  (60  parts)  and  phenol  (40  parts). 

Therapeutics. — On  account  of  its  insolubility  in  water,  salol  is 
not  employed,  to  any  extent,  as  a  local  antiseptic,  except  at  times  in 
alcoholic  solution.  We  find  its  chief  use  as  an  intestinal  antiseptic. 
Like  other  salicylic  compounds,  it  is  used  in  the  various  forms  of 
rheumatism.     It  may  be  prescribed  in  powders  or  capsules  in  diarrheas 


44  ANTISEPTICS,    DISINFECTANTS    AND    DEODORANTS. 

and  other  intestinal  fermentations.     Large  doses  must  be  avoided  on 
account  of  the  possible  poisoning  by  phenol  which  is  liberated. 

In  cases  of  neuralgia  associated  with  rheumatism,  the  salicylates 
combined  with  some  hypnotic  drug  is  especially  indicated.  A  powder 
composed  of  5  gr.  (0.3  gm.)  of  salol  and  4  gr.  (0.27  gm.)  of  phenacetin 
to  the  dose  is  a  useful  combination. 


ASPIRIN. 

(Acetyl-salicylic  Acid;   CQH804.) 

Aspirin  is  the  acetyl  derivative  of  salicylic  acid.  It  occurs  in  the 
form  of  small,  colorless,  crystalline  needles,  odorless,  and  having  an 
acidulous  taste;  soluble  in  100  parts  of  water,  freely  soluble  in  alcohol 
and  ether.  Boiling  water  decomposes  the  drug  into  acetic  acid  and 
salicylic  acid  or  a  salicylate.  The  dose  is  from  5-15  gr.  (0.3-1.0  gm.) 
in  capsules  or  wafers,  and  should  be  dispensed  in  wax  paper,  free  from 
moisture. 

Physiologic  Action  and  Therapeutics. — Aspirin  passes  through 
the  stomach  unchanged,  the  decomposition  being  in  the  intestine. 
Its  action  is  similar  to  that  of  salicylic  acid,  over  which  it  possesses  the 
advantage  of  producing  less  of  the  undesired  local  and  systemic  side 
effects,  due  to  the  slow  liberation  and  assimilation  of  the  salicylic  acid. 
Small  doses,  however,  produce  in  some  subjects  swellings  about  the 
head  and  face,  and  occasionally  erythematous  rash. 

Incompatibles. — -Heat,  moisture,  alkalies,  their  carbonates  and 
bicarbonates.     It  keeps  well  when  properly  protected. 

SALOPHEN. 

CAcetyl-paramido-phenyl  Salicylate.) 

Salophen  is  an  unofficial  compound  of  salicylic  acid.  It  occurs  in 
white  scales,  tasteless  and  odorless,  insoluble  in  water,  but  soluble  in 
alcohol  and  ether.  On  account  of  the  liability  to  poisoning  from  the 
phenol  which  is  liberated  in  the  intestine  from  salol,  this  compound 
was  introduced.  It  contains  about  50  per  cent,  of  salicylic  acid,  and  is 
decomposed  by  the  alkaline  fluids  of  the  intestine  into  salicylic  acid  and 
a  comparatively  nonpoisonous  compound,  acetyl-paramido-phenyl. 
The  dose  is  from  5-30  gr.  (0.3-2.0  gm.). 

Physiologic  Action  and  Therapeutics. — The  action  of  salophen 
is  similar  to  other  salicylic  compounds.  While  it  is  not  as  efficacious  in 
rheumatism  as  sodium  salicylate,  it  being  tasteless  and  unirritating  to 


vol  \  i  hi.  Dii.  croup.  45 

the  stomach  can  be  given  before  meals  in  the  milder  manifestations  of 
the  disease.  In  cases  of  neuralgia  of  rheumatic  origin  associated  with 
acute  pain,  salophen  may  be  combined  with  such  drugs  as  phenacetin 
and  codein  sulphate.  A  powder  composed  of  5  gr.  (0.3  gm.)  each  of 
salophen  and  phenacetin  and  1/4  gr.  (0.016  gm.)  codein  sulphate  is 
a  valuable  combination. 


SODII  SALICYLAS— U.  S.  P. 
(Sodium  Salicylate;  NaC7H603.) 

Sodium  salicylate  occurs  as  a  white  amorphous  powder,  without 
odor,  but  of  a  sweetish,  saline  taste.  It  is  freely  soluble  (0.8  parts)  in 
water  and  in  6  parts  in  alcohol  and  in  glycerin.  The  dose  is  from 
5-20  gr.  (0.3-1.3  gm.). 

Physiologic  Action  and  Therapeutics. — The  action  of  this 
salt  is  the  same  as  that  of  salicylic  acid.  It  has  the  advantage,  however, 
of  being  more  soluble  and  less  irritating  to  the  stomach.  It  is  probably 
the  most  generally  used  of  all  the  salicylic  compounds,  and  is  especially 
indicated  in  the  acute  stage  of  rheumatism.  In  cases  of  pyorrhea  as- 
sociated with  rheumatism  it  may  be  given  in  5  gr.  (0.3  gm.)  doses  after 
meals,  well  diluted  with  water. 

Sodium  salicylate  is  discussed  here  more  because  of  its  relation 
to  the  previously  considered  drugs  than  because  of  its  antiseptic 
properties.     It  is  not  considered  a  very  efficient  antiseptic. 

.        VOLATILE  OIL  GROUP. 

A  true  classification  of  this  general  group  is  not  practicable.  The 
volatile  oils  vary  so  markedly  in  their  physical  and  chemic  make-up 
that  only  those  which  possess  antiseptic  properties,  and  are  employed 
in  dental  practice  as  such,  will  be  considered  here.  As  a  class  the 
volatile  oils  have  enjoyed  a  wide  range  of  usefulness  as  antiseptic 
remedies  in  the  past.  Some  are  useful  remedies  to  be  applied  to 
carious  cavities  in  vital  teeth,  where  the  pulp  is  involved,  because  of 
their  penetrating  and  slightly  analgesic  properties.  Those  which  are 
just  sufficiently  irritating  to  stimulate  the  pulp  to  healthy  activity  are 
the  ones  especially  indicated  for  this  purpose.  These  will  be  mentioned 
later.  For  years  the  volatile  oils  were  employed  in  an  effort  to  disinfect 
putrescent  root-canals.  In  this  they  have  proved  to  be  a  dismal 
failure.  Here  the  noxious  products  of  pulp  decomposition  are  sur- 
rounded by  hard  tooth-structure  and  removed  from  live  animal  tissue,. 


46  ANTISEPTICS,    DISINFECTANTS   AND    DEODORANTS. 

therefore,  we  are  justified  in  using  true  disinfectants — agents  which  will 
kill  the  germs  and  destroy  their  by-products.  To  use  any  of  the  es- 
sential oils  for  this  purpose  to-day,  is  but  to  adhere  to  the  old  empirical 
method  of  treatment. 

OLEUM  CAJUPUTI— U.  S.  P. 

(Oil  of  Cajuput.) 

Oil  of  cajuput  is  a  thin,  bluish-green,  volatile  oil  distilled  from 
the  fresh  leaves  and  twigs  of  Melaleuca  leucadendron,  a  small  tree 
growing  in  the  East  Indies.  It  has  a  camphoraceous  odor  and  an 
aromatic,  bitter  taste.  Its  chief  constituent  is  cineol,  of  which  it 
should  contain  not  less  than  55  per  cent,  by  volume. 

Physiologic  action  and  therapeutics  resemble  those  of  oil 
of  cloves  and  oil  of  eucalyptus. 

OLEUM  CINNAMOMI— U.  S.  P. 

(Oil  of  Cinnamon.) 

Oil  of  cinnamon  is  a  yellowish  or  brownish  volatile  oil  distilled 
from  the  bark  of  the  shoots  of  cassia  cinnamomum,  a  tree  which  grows 
in  China.  The  oil  is  sometimes  commercially  called  oil  of  cassia. 
A  species  of  cinnamon  which  grows  in  the  Ceylon  Islands  produces 
a  volatile  oil  having  a  finer  flavor,  though  less  employed.  It  has  the 
characteristic  odor  of  cinnamon  and  a  spicy,  burning  taste.  The 
chief  constituent  of  oil  of  cinnamon  is  cinnamic  aldehyd,  also  official, 
and  of  which  it  should  contain  "hot  less  than  75  per  cent,  by  volume. 
There  are  two  official  preparations  of  oil  of  cinnamon;  both  are 
valuable  in  dental  practice.  Aqua  cinnamomi  (cinnamon  water)  used 
as  a  spray  and  as  a  vehicle  for  mouth-washes,  and  spiritus  cinna- 
momi (spirit  of  cinnamon)  used  largely  as  a  flavoring  agent. 

CINNALDEHYDUM— U.  S.  P. 

(Cinnamic  Aldehyd;  C9H80.) 

Cinnamic  aldehyd  is  a  colorless  liquid  obtained  from  the  oil  of 
cinnamon  or  prepared  synthetically.  It  has  a  cinnamon-like  odor, 
and  a  burning,  aromatic  taste.  Sparingly  soluble  in  water,  freely  in 
alcohol,  fixed  and  volatile  oils.  Pure  synthetic  cinnamic  aldehyd 
has  largely  displaced  the  natural  oil  of  cinnamon  and  may  be  used 
for  nearly  all  purposes  for  which  the  latter  is  employed. 


OLEUM    CARYOPHYLT.I.  47 

Physiologic  Action. — Oil  of  cinnamon  and  cinnamic  aldehyd 
arc  active  antiseptics.  Both  are  rather  irritant  to  the  pulp  and  peri- 
cemental membrane.  Cinnamon  is  an  agreeable  aromatic  stimulant, 
carminative,  and  stomachic.  It  is  also  claimed  to  possess  feebly 
astringent  properties.  It  enters  into  aromatic  fluid  extracts  and  also 
into  many  of  the  compound  tinctures. 

Therapeutics. — Oil  of  cinnamon  has  been  employed  in  root- 
canal  treatment,  but  because  of  its  irritant  properties  and  of  its  liabil- 
ity to  stain  the  tooth-structure,  it  should  be  used  cautiously,  if  at  all. 
It  is  a  constituent  of  Black's  1-2-3  mixture  which  contains  oil  of 
cinnamon  1  part,  oil  of  wintergreen  2  parts,  and  phenol  (carbolic  acid) 
3  parts.  The  most  practical  use  that  can  be  made  of  oil  of  cinnamon 
in  dental  practice,  however,  is  as  a  flavoring  agent.  The  official  water 
may  be  employed  as  a  vehicle  for  mouth-washes  and  sprays.  Every 
dentist  should  know  how  to  prepare  the  solution  (see  p.  8),  as  it 
should  be  freshly  made  and  used  freely  in  prophylactic  and  phyor- 
rheal  treatment. 

OLEUM  CARYOPHYLLI— U.  S.  P. 

(Oil  of  Cloves.) 

Oil  of  cloves  is  a  thin,  pale  yellow,  volatile  oil  distilled  from 
cloves,  the  dried -flower  buds  of  Eugenia  aromatica,  a  shrubby  ever- 
green, introduced  and  cultivated  in  the  East  Indies.  It  has  a  strong 
aromatic  odor  of  cloves  and  a  pungent,  spicy  taste.  Its  chief  constit- 
uent is  engenol,  which  is  also  official,  and  of  which  it  should  contain 
not  less  than  80  per  cent,  by  volume. 

EUGENOL— U.  S.  P. 
(Eugenol;  CIOHI202.) 

Eugenol  is  an  aromatic  phenol  obtained  from  oil  of  cloves  and 
other  sources.  It  occurs  as  a  thin,  colorless  or  pale  yellow  liquid, 
highly  refractive,  and  possessing  a  strongly  aromatic  odor  of  cloves 
and  a  pungent,  spicy  taste.  It  is  practically  insoluble  in  water,  but 
freely  soluble  in  alcohol.  It  may  be  used  instead  of  oil  of  cloves,  of 
which  it  is  the  chief  constituent;  it  is  also  the  chief  constituent  of  oil 
of  pimenta  (allspice). 

Physiologic  Action. — Oil  of  cloves  is  just  sufficiently  irritant 
to  the  animal  cell  to  be  classed  as  an  ideal  antiseptic.  It  also  possesses 
marked  local  analgesic  properties.  Internally  administered,  it  is  a 
powerful  carminative  and  stimulant. 


48  ANTISEPTICS,    DISINFECTANTS    AND    DEODORANTS. 

Therapeutics. — -Because  of  its  antiseptic  and  local  analgesic 
properties,  oil  of  cloves  is  one  of  the  most  valuable  volatile  oils.  It 
has  long  been  a  popular  remedy  for  odontalgia  (toothache).  Oil  of 
cloves,  or  its  chief  constituent,  eugenol,  are  excellent  agents  to  be  em- 
ployed as  the  liquid  for  making  pastes  when  pulp-capping  is  indicated. 
A  paste  made  of  precipitated  calcium  phosphate  or  pure  zinc  oxid, 
to  either  of  which  2  per  cent,  of  thymol  has  been  incorporated,  as 
the  powder  and  oil  of  cloves  or  eugenol,  as  the  liquid,  is  a  valuable 
remedy  for  capping  the  pulp,  or  protecting  this  organ  when  it  is  in- 
volved from  a  deep-seated  carious  cavity.  (See  Practical  Thera- 
peutics, p.  137.)  Applied  to  a  canker  sore  or  in  cases  of  ulcerative 
stomatitis,  oil  of  cloves  will  prove  to  be  one  of  the  best  healing  agents. 
It  is  a  counter-irritant,  and  as  such  will  stimulate  morbid  processes. 


'  OLEUM  EUCALYPTI— U.  S.  P. 

(Oil  of  Eucalyptus.) 

Oil  of  eucalyptus  is  a  colorless,  or  faintly  yellowish  volatile  oil 
distilled  from  the  fresh  leaves  of  Eucalyptus  globulus,  a  tree  which 
grows  in  the  swampy  regions  of  Australia  and  California.  It  has 
a  characteristic,  aromatic,  somewhat  camphoraceous  odor  and  a  pun- 
gent, spicy,  and  cooling  taste.  The  chief  constituent  is  eucalyptol, 
also  official. 


EUCALYPTOL— U.  S.  P. 

(Eucalyptol;  CIOHl80.) 

Eucalyptol  is  a  colorless  liquid,  obtained  from,  oil  of  eucalyptus 
and  several  other  volatile  oils,  especially  oil  of  cajuput.  It  is  an 
organic  oxid,  probably  identical  with  cineol,  the  chief  constituent  of 
oil  of  cajuput.  It  has  a  characteristic  and  distinctly  camphoraceous 
odor  and  a  pungent,  spicy,  and  cooling  taste.  Almost  insoluble  in 
water,  freely  soluble  in  alcohol. 

Physiologic  Action. — Locally  applied,  both  oil  of  eucalyptus  and 
eucalyptol  are  antiseptics,  but  have  an  irritant  action.  Commercial  oil 
of  eucalyptus  is  so  irritating  that  it  should  not  be  employed  in  root-canal 
treatment.  Many  cases  of  pericementitis  have  been  produced  by 
commercial  oil  of  eucalyptus  having  been  sealed  in  the  canals  of  teeth. 
Eucalyptol  is  also  irritant,  but  not  nearly  so  irritant  as  commercial  oil 
of  eucalyptus.     When  desired  to  be  used  in  root-canal  treatment, 


OLEUM     Ml  N  1  II  1.     PIP]   KM    i  .  49 

eucalyptol  should  be  employed,  or  a  refined  specimen  of  the  oil  which  is 
practically  all  eucalyptol. 

Therapeutics. — Both  oil  of  eucalyptus  and  eucalyptol  have  been 
employed  in  root-canal  treatment.  Like  all  of  the  volatile  oils,  they 
are  practically  worthless  as  remedies  for  correcting  putrescent  pulp 
conditions  where  they  have  been  largely  employed  in  the  past.  While 
eucalyptol  is  not  nearly  as  irritant  as  the  oil  of  eucalyptus,  it  is  still  too 
irritant  to  be  sealed  in  a  canal  as  an  antiseptic  remedy  after  the  removal 
of  a  live  pulp.  Agents,  such  as  oil  of  cloves  or  eugenol,  having  local 
analgesic  as  well  as  antiseptic  properties,  are  far  preferable.  Oil  of 
cajuput,  containing  cineol,  a  compound  identical  with  eucalyptol,  has 
a  solvent  action  on  gutta-percha,  as  has  also  eucalyptol,  hence  these 
agents  find  their  greatest  use  in  dental  practice  as  remedies  for  moisten- 
ing root  canals  previous  to  filling  with  gutta-percha.  The  author's 
formula  for  a  remedy  to  be  used  for  this  purpose  is:  Menthol  2  gr. 
(0.14  gm.),  thymol  3  gr.  (0.2  gm.),  eucalyptol  1  dr.  (4  c.c).  This 
remedy  is  called  eucalyptol  compound. 

Oil  of  Eucalyptus  is  an  excellent  remedy  in  chronic  inflammation 
of  mucous  membranes,  where  it  can  be  used  as  a  spray  combined  with 
liquid  petroleum  in  the  proportion  of  30-60  minims  to  the  ounce 
j  4  c.c.  to  32  gm.). 

An  infusion  of  eucalyptus  leaves  (5  per  cent.)  can  be  used  as  a 
mouth-wash  or  gargle  in  stomatitis. 

As  a  stimulant  expectorant  eucalyptus  is  of  great  value  in  colds 
and  chronic  bronchial  catarrh.  A  few  drops  of  the  oil  of  eucalyptus, 
or  eucalyptol,  can  be  dropped  into  hot  water  and  the  steam  inhaled. 

OLEUM  MENTHA  PIPERITA— U.  S.  P. 

(Oil  of  Peppermint.) 

Oil  of  peppermint  is  a  colorless,  or  pale  green  volatile  oil,  distilled 
from  the  fresh  or  partly  dried  leaves  and  flowering  tops  of  Mentha  piperita, 
having  the  characteristic  strong  odor  of  the  latter  plant  and  a  strong. 
aromatic,  pungent  taste,  followed  by  a  cool  sensation  upon  inhalation. 
Its  chief  constituent  is  menthol,  also  official,  and  of  which  it  should  yield 
not  less  than  50  per  cent.  There  are  two  official  preparations  of  oil  of 
peppermint,  both  of  which  are  useful  in  dental  practice. 

Aqua  menthse  piperita,*  (peppermint  water),  used  as  a  spray, 
as  a  vehicle  for  mouth-washes  and  local  anesthetic  solutions. 

Spiritus  menthae  piperita'   ^spirit  of  peppermint)  is  used  als< 
a  flavoring:  accent. 


50  ANTISEPTICS,    DISINFECTANTS    AND    DEODORANTS. 

MENTHOL— U.   S.  P. 

(Menthol;  CIOH200). 

Menthol  is  a  stearoptene,  or  secondary  alcohol,  obtained  from  the 
oil  of  peppermint.  It  occurs  in  colorless,  acicular,  or  prismatic  crystals, 
having  a  strong  and  characteristic  odor  of  peppermint,  and  a  warm, 
aromatic  taste,  followed  by  a  sensation  of  cold  when  air  is  inhaled. 
Sparingly  soluble  in  water,  freely  in  alcohol,  ether,  and  chloroform. 
When  triturated  with  about  equal  amounts  of  phenol,  thymol,  camphor, 
or  chloral,  it  forms  a  liquid. 

Physiologic  Action. — Oil  of  peppermint  and  menthol  are 
antiseptics,  as  well  as  possessing  local  analgesic  properties  to  a  marked 
degree.  Like  many  other  volatile  oils  of  an  aromatic  character,  oil  of 
peppermint  is  a  valuable  carminative,  stimulant,  antifermentative, 
and  antispasmodic. 

Therapeutics. — Oil  of  peppermint,  or  menthol,  is  an  ingredient 
of  many  remedies  for  obtunding  sensitive  dentin.  A  useful  formula 
consists  of  menthol  20  gr.  (1.33  gm.),  chloroform  2  fl.  dr.  (8.0  c.c), 
and  ether  6  fl.  dr.  (24.0  c.c).  The  official  water  is  an  excellent 
vehicle  for  local  anesthetic  solutions,  as  well  as  for  mouth-washes  and 
sprays.  Menthol  is  a  constituent  of  many  dental  liniments  for  neural- 
gia and  pericementitis.  A  good  liniment  for  this  purpose  contains 
menthol  20  gr.  (1.33  gm.),  chloroform  1  1/2  fl.  dr.  (6.0  c.c),  and 
tincture  of  aconite  6  fl.  dr.  (24.00  c.c). 

Oil  of  peppermint,  or  menthol,  is  a  constituent  of  many  lotions 
and  sprays  for  the  local  treatment  of  diseases  of  the  mouth,  ear,  nose, 
and  throat.  Menthol  is  used  extensively  in  headache,  being  rubbed  on 
the  forehead  or  inhaled  from  a  metal  container.  In  cases  of  itching 
of  the  skin  or  mucous  membrane,  menthol  is  a  valuable  remedy  be- 
cause of  its  analgesic  properties.  For  this  purpose  it  should  be  dis- 
solved in  a  bland  oil,  like  liquid  petroleum,  in  the  proportion  of  30 
grains  to  the  ounce  (2.0  gm.-3o.o  c.c).  It  is  also  a  constituent  of 
phenol  compound  (see  p.  51). 

OLEUM  THYMI— U.  S.  P. 

(Oil  of  Thyme.) 

Oil  of  thyme  is  a  thin,  colorless  or  pale  yellow  volatile  oil,  distilled 
from  Thymus  vulgaris^  a  common  shrub  (garden  thyme)  which  is 
indigenous  to  France,  but  cultivated  in  the  gardens  of  the  United  States. 
It  has  a  strong  odor  of  thyme,  and  a  warm  pungent  and  afterward 
cooling  taste.     Its  chief  constituent  is  thymol,  which  is  official. 


THYMOL — IODUM.  5 1 

THYMOL— U.  S.  P. 
(Thymol;  CioHmO.) 

Thymol  is  a  phenol  obtained  from  the  oil  of  thyme.  It  occurs  in 
large,  colorless,  translucent  crystals,  having  a  thyme-like  odor  and  a 
pungent,  aromatic  taste,  with  a  slight  caustic  effect  upon  the  lips  and 
mucous  membranes.  It  is  sparingly  soluble  (about  noo  parts)  in  water 
and  in  less  than  its  own  weight  in  alcohol,  ether,  and  chloroform,  also 
readily  soluble  in  fixed  and  volatile  oils.  When  triturated  with  about 
equal  quantities  of  phenol,  menthol,  camphor,  or  chloral,  it  liquefies. 

Physiologic  Action. — Thymol  is  a  powerful  antiseptic.  It 
might  almost  be  classed  as  a  true  disinfectant.  It  resembles  phenol  in 
its  action,  but  being  slowly  absorbed  is  far  less  poisonous,  yet  vastly 
superior  to  it  as  an  antiseptic.  It  possesses  a  peculiar,  but  favorable 
action  on  animal  tissue.  It  undoubtedly  has  a  preservative  action  on 
dead  animal  tissue.  It  is  a  stimulant  though  not  irritant  or  corrosive, 
and  also  has  local  analgesic  properties. 

Therapeutics. — Oil  of  thyme  is  not  much  used  in  dental  practice 
except  as  a  source  from  which  thymol  is  obtained.  Thymol  has  not 
been  used  to  the  extent  which  its  importance  merits,  although  it  is 
rapidly  gaining  favor  with  modern  therapeutists.  It  is  a  constituent 
of  many  remedies  for  root-canal  treatment  after  live  pulps  have  been 
removed.  The  author's  phenol  compound  for  this  purpose  contains 
menthol,  20  gr.  (1.3  gm.),  thymol,  40  gr.  (2.6  gm.),  and  phenol 
(U.  S.  P.)  3  drams  (12.0  c.c).  Dr.  E.  C.  Kirk  suggests  using  equal 
parts  of  thymol  and  phenol,  called  thymophen.  Dr.  H.  Prinz  uses 
thymol,  camphor  and  phenol,  called  thymocamphen.  A  solution  of  a 
grain  (0.06  gm.)  to  the  ounce  of  water  (30.0  c.c),  with  a  little  alcohol 
used  as  a  solvent,  makes  a  good  mouth-wash  in  the  infectious  forms 
of  stomatitis  and  pharyngitis  (Stevens).  It  is  a  constituent  of  the  official 
mouth- wash,  liquor  antisepticus  (see  p.  40). 

IODUM— U.  S.  P. 
(Iodin;  I.  I.) 

Iodin  is  a  nonmetallic  element  obtained  chiefly  from  the  ashes 
of  sea-weeds.  It  occurs  in  heavy,  bluish-black,  friable  crystals, 
having  a  metallic  luster,  a  distinctive  odor,  and  a  sharp,  acrid  taste. 
On  heating,  it  emits  a  violet-colored  vapor.  Iodin  is  sparingly  soluble 
in  water  (5,000  parts),  freely  in  alcohol,  ether,  chloroform,  and  in  a 
solution  of  potassium  iodid. 


52  ANTISEPTICS,    DISINFECTANTS    AND    DEODORANTS. 

The  three  official  preparations  are  of  value  in  dental  practice. 
They  are: 

Liquor  Iodi  Compositus,  U.  S.  P.  Compound  Solution  of 
Iodin  (Lugol's  Solution;  5  per  cent,  of  Iodin  in  a  10  per  cent, 
solution  of  Potassium  Iodid). 

Tinctura  Iodi,  U.  S.  P.,  Tincture  of  Iodin,  (7  per  cent.). 
Unguenrum  Iodi,  U.  S.  P.,  Iodin  Ointment,  (4  per  cent.). 


•  IODOFORMUM— U.  S.  P. 

(Iodoform;  CHI3). 

Iodoform  is  methyl  tri-iodid,  made  by  heating  in  a  closed  vessel 
iodin,  alcohol,  sodium  hydrate,  and  water,  wherein  3  atoms  of  hydro- 
gen of  the  methane  radicle  "(CH4)  is  displaced  by  3  of  iodin.  It 
occurs  in  small,  lemon-yellow,  hexagonal  crystals,  having  a  peculiar, 
very  penetrating,  and  persistent  odor,  and  an  unpleasant,  slightly 
sweetish,  and  iodin-like  taste.  It  is  very  feebly  soluble  in  water, 
soluble  in  about  47  parts  of  alcohol,  and  freely  soluble  in  ether,  chloro- 
form, and  oils.  It  contains  about  96  per  cent,  of  iodin.  The  official 
ointment  of  iodoform  contains  10  per  cent. 

IODOLUM— U.  S.  P. 

(Iodol;  Tetra-iodo-pyrrol;  C4I4NH.) 

Iodol,  or  tetra-iodo-pyrrol,  is  a  derivative  of  the  base  pyrrol 
(C4H5N),  obtained  by  the  direct  action  of  iodin  upon  the  base  in 
the  presence  of  alcohol.  It  occurs  as  a  yellowish,  crystalline  pow- 
der, without  odor  or  taste,  and  contains  about  90  per  cent,  of  iodin. 
Iodol  is  practically  insoluble  in  water,  but  freely  soluble  in  alcohol, 
ether,  and  ojls^.  It'  is  used  as  a  substitute  for  iodoform,  and,  though 
more  expensive,  .has  the  decided  advantage  in  being  odorless.  - 

THYMOLIS  IODIDUM— U.  S.  P. 

(Thymob  Iodid;  »Di-thymol-di-iodid;  Aristol;  C2OH2402I2.) 

Thymol  iodid  or  aristol,  is  obtained  by  acting  upon  thymol  in 
aqueous  solution  of  sodium  hydrate  with  iodin  dissolved  in  a  solution 
of  potassium  iodid.  It  occurs  as  a  brownish-red  powder,  tasteless 
and  almost  odorless,  and  contains  about  45  per  cent,  of  iodin.  It 
is  nearly  insoluble  in  'water,  but  freely  soluble  in  ether,  chloroform, 
and  oils.     It  is  used  as  a  substitute  for  iodoform,  but  is  rather  un- 


KUROPHEN — NOSOPJI!  \.  53 

stable,  being  decomposed  by  heat,  light,  acids,  alkalies,  alcohol,  and 
corrosive  sublimate.  It  is  more  expensive  than  iodoform  and  less 
effective. 

EUROPHEN  (Not  Official). 
(Di-isobutyl-ortho-cresol-iodid;  C22H2g02I.) 

Europhen  is  obtained  in  exactly  the  same  manner  as  that  of  pre- 
paring aristol,  except  isobutyl-ortho-cresol  is  substituted  for  the  thy- 
mol. It  occurs  as  a  very  bulky,  yellow,  amorphous  powder,  of  an 
aromatic  odor,  and  contains  28  per  cent,  of  iodin.  It  is  insoluble  in 
water  and  glycerin,  but  freely  soluble  in  alcohol,  ether,  and  oils.  In 
dental  practice  it  is  an  excellent  substitute  for  iodoform,  and  is  far  more 
stable  than  aristol. 

NOSOPHEN  (Not  Official). 
(Tetra-iodo-phenol-phthalein;   (C6H2I2OH)2C8H402.) 

Nosophen  is  obtained  by  the  action  of  iodin  on  a  solution  of 
phenol-phthalein.  It  is  a  pale  yellow  powder,  without  odor  and  taste, 
and  contains  60  per  cent,  of  iodin.  It  differs  from  iodoform  in  being 
an  active  antiseptic  and  in  not  yielding  its  iodin  to  the  tissues. 

Physiologic  Actions. — Iodin  can  be  classed  as  an  ideal  anti- 
septic in  that  it  is  just  sufficiently  irritant  to  the  animal  cell  to  cause 
stimulation,  giving  to  the  latter  new  life  and  energy  whereby  the  animal 
cells  attacks  and  kills  the  invading  germ,  thus  producing  nature's 
method  of  disinfection. 

When  applied  to  the  skin  or  mucous  membrane  it  produces  a 
yellowish-brown  or  black  stain,  and  acts  as  an  irritant  or  caustic, 
according  to  the  strength  of  the  solution  used,  and  the  frequency  of  the 
application.  This  discoloration  can  be  readily  removed  by  solutions 
of  potassium  cyanid,  sodium  hyposulphite  or  ammonia.  When  tinc- 
ture of  iodin  is  frequently  applied,  vesication  is  produced,  or  perhaps 
sloughing.  The  blood-vessels  subjacent  to  the  area  to  which  it  is 
applied  are  reflexly  dilated,  hence  this  drug  is  an  efficient  counter- 
irritant. 

When  internally  administered,  it  is  rapidly  absorbed  in  the  form 
of  iodids  and  soon  reappears  in  all  the  secretions  of  the  body;  the 
bulk  being  eliminated,  however,  in  the  urine,  also  in  the  form  of  iodids. 
The  continuous  use  is  followed  by  a  group  of  symptoms  known  as 
iodism.  The  more  common  manifestations  of  this  condition  are  associ- 
ated with  the  mucous  membrane  of  the  respiratory  tract  and  with  the 


54  ANTISEPTICS,    DISINFECTANTS    AND    DEODORANTS. 

skin,  consisting  of  frontal  headache,  lacrimation,  coryza,  soreness 
of  the  throat,  an  increased  flow  of  saliva,  and  sometimes  an  eruption 
on  the  skin.  The  amount  of  the  drug  required  to  produce  iodism 
varies  with  different  individuals.  Iodoform  differs  somewhat  in  its 
action  from  iodin.  Instead  of  being  an  irritant,  it  acts  as  a  mild  an- 
algesic when  applied  to  the  mucous  membrane  and  abraded  surfaces, 
especially  the  latter.  Iodoform,  and  allied  compounds,  have  a  favor- 
able action  on  infected  wounds,  but  how  the  result  is  produced  is 
not  understood.  It  is  known  that  as  dry  powders  they  possess  little  or 
no  bactericidal  action,  yet  when  applied  to  raw  surfaces  they  retard 
germ-growth,  probably  through  the  free  iodin  liberated,  as  they  nearly 
all  liberate  their  contained  iodin  when  in  contact  with  the  fluids  of 
the  tissues. 

Therapeutics. — Applied  to  infected  wounds,  iodin  is  an  efficient 
antiseptic.  The  tincture  of  iodin  or  the  compound  solution  may  be 
employed  in  full  strength,  or  diluted,  to  sluggish  ulcers  and  abscess 
cavities,  or  in  cases  of  local  arsenical  poisoning.  For  the  latter  condi- 
tion, a  creamy  paste  made  of  europhen  and  liquid  petroleum  can  be 
applied  to  the  affected  part  on  sterile  gauze  or  cotton.  Where  pain  is 
a  prominent  symptom,  as  in  cases  of  lacerated  gum  tissue  and  exposed 
process  after  extraction,  othoform  (40  parts)  can  be  mixed  with  euro- 
phen (60  parts)  and  made  into  a  paste  with  liquid  petroleum.  Applied 
in  the  same  manner  it  will  stop  the  pain  like  magic.  This  paste  is 
called  euroform.  As  a  counterirritant  iodin  is  a  valuable  drug,  as  the 
blood-vessels  subjacent  to  the  area  to  which  it  is  applied  are  reflexly 
dilated.  The  tincture  of  iodin  in  full  strength  should  not  be  used  as  a 
dental  counterirritant  because  of  its  local  destructive  action  on  the 
mucous  membrane.  For  this  purpose  the  compound  solution  should 
be  employed  or  the  tincture  of  iodin  modified.  A  favorite  combination 
is  tincture  of  aconite  2  parts,  tincture  of  iodin  and  chloroform,  of  each, 
1  part.  The  chloroform  volatilizes  rapidly  when  applied  and  the 
irritant  action  of  the  iodin  is  modified  by  the  aconite,  a  local  sedative. 
This  remedy  is  especially  valuable  in  cases  of  pericementitis  where 
a  mild  but  persistent  counterirritant  effect  is  desired. 

Iodin  will  stain  the  tooth-structure  and  there  is  no  necessity  for 
using  the  drug  within  the  tooth,  as  other  remedies  are  at  hand  which 
will  accomplish  all  that  can  be  expected  of  iodin  without  discoloration. 

Iodin  is  useful  as  an  antiseptic  and  stimulant  in  the  treatment  of 
pyorrhea  and  will  be  referred  to  again  in  Practical  Therapeutics  (p.  347). 
Iodoform  has  little  use  in  dental  therapeutics  except  iodoform  gauze, 
which  is  used  in  packing  surgical  wounds,  abscess  cavities,  etc. 


BETW  \  I'll  I  ll<  II — RESORCINOL.  55 

BETANAPHTHOL— U.  S.  P. 
(Betanaphthol;  CIOH7OH.) 

Betanaphthol  is  a  monatomic  phenol  occurring  in  coal-tar,  but 
usually  prepared  artifically  from  naphthalene.  It  occurs  in  white, 
shilling  crystalline  scales,  or  as  a  yellowish-white  crystalline  powder, 
having  a  faint,  phenol-like  odor  and  a  sharp,  pungent,  but  not  per- 
sistent taste.  It  is  sparingly  soluble  in  water,  freely  in  alcohol,  ether, 
and  chloroform.  It  should  be  kept  in  dark  amber-colored,  well- 
stoppered  bottles.     The  dose  is  from  2-10  gr.  (0.13-0.6  gm.). 

Physiologic  Action.- --Betanaphthol  is  antiseptic,  antifermenta- 
tive,  deodorant,  and  may  also  be  considered  a  disinfectant.  Its  action 
closely  resembles  that  of  phenol,  but  is  less  poisonous. 

When  applied  locally  to  the  skin  or  mucous  membrane,  betanaph- 
thol is  readily  absorbed,  and,  in  concentrated  solutions,  it  is  irritating 
to  the  tissues  to  which  it  is  applied.  Toxic  symptoms  may  result  from 
its  absorption  by  the  skin,  which  also  resemble  those  of  phenol. 

Therapeutics. — Betanaphthol  has  been  recommended  as  a  con- 
stituent of  root-canals  filling  material.  It  will  not  corrode  metal  in- 
struments, therefore  solutions  can  be  used  for  immersing  instruments 
during  the  surgical  treatment  of  pyorrhea  and  other  operations.  The 
solubility  of  the  drug  is  increased  in  boiling  water.  A  suitable  solution 
can  be  prepared  in  hot  water  and  used  when  sufficiently  cooled.  Some 
of  the  drug  will  be  precipitated  as  the  solution  cools,  but  as  it  is  not 
irritating  in  this  strength  solutions  it  does  not  matter  materially.  The 
saturated  aqueous  solution  may  also  be  employed  to  irrigate  wounds 
and  as  a  constituent  of  mouth-washes. 

In  medicine  it  is  used  as  a  parasiticide  in  certain  diseases  of  the 
skin,  as  scabies  (itch)  and  ring-worm.  It  is  best  to  employ  it  in  the 
form  of  an  ointment  in  the  strength  of  a  dram  (4.0  gm.)  to  the  ounce 
(30.0  gm.),  for  in  this  way  it  is  not  irritating. 

RESORCINOL—U.  S.  P. 
(Resorcin;  C6H4  (OH)2.) 

Resorcin  is  a  diatomic  phenol  occurring  in  the  form  of  colorless 
or  faintly  reddish,  needle-shaped  crystals,  or  rhombic  plates,  having 
a  faint  peculiar  odor  and  a  sweetish,  and  afterward  pungent  taste. 
It  is  freely  soluble  in  water,  alcohol,  ether,  and  glycerin.  It  darkens 
when  exposed  to  light  and  air  and  should  be  kept  in  dark  amber- 
colored,  well-stoppered  bottles.    The  dose  is  from  3-8  gr.  (0.2-0.5  8m-)- 

Physiologic    Action. — Resorcin    acts    very    much    like    phenol, 


56  ANTISEPTICS,    DISINFECTANTS   AND    DEODORANTS. 

but  is  less  poisonous  and  less  irritant.  It  has  marked  antiseptic  proper- 
ties, and  being  practically  nonirritating  is  a  useful  drug  in  the  treatment 
of  many  pathologic  conditions  about  the  mouth  and  throat. 

Therapeutics. — Resorcin  has  been  used  for  keeping  instruments 
sterile  during  surgical  operations,  but  its  continued  use  will  affect  the 
metal.  In  a  2  to  5  per  cent,  solution  it  is  efficacious  as  a  mouth-wash  or 
gargle  in  the  treatment  of  certain  subacute  and  chronic  conditions  of 
the  mucous  membrane,  as  in  ulcerative  stomatitis,  pharyngitis,  laryngi- 
tis, whooping-cough,  and  diphtheria.  An  ointment  of  resorcin  (5  per 
cent.)  is  an  excellent  remedy  to  apply  to  sloughing  wounds,  foul  ulcers, 
and  syphilitic  ulcers.  A  dusting  powder,  consisting  of  1  part  resorcin 
and  10  parts  boric  acid,  can  be  used  with  much  benefit  in  cases  of 
suppurating  wounds.  As  a  remedy  for  dandruff  of  the  scalp,  Stevens 
recommends  the  following:  Resorcin  1  1/2  dr.  (6.0  gm.),  castor  oil 
n^xx-xxx  (1.2  —  2.0  c.c),  bay-rum  3  1/2  fl.  Oz.  (105.0  c.c). 

CARBO— CARBON. 

Carbon  is  official  in  the  following  forms:  Animal  charcoal,  puri- 
fied animal  charcoal,  and  wood  charcoal.  Animal  charcoal,  or  bone- 
black,  is  prepared,  by  burning  bones  in  closed  iron  cylinders.  It  is 
composed  of  carbon  and  certain  earthy  salts  (calcium  carbonate  and 
phosphate).  Purified  animal  charcoal  is  bone-black  from  which  the 
above-mentioned  salts  have  been  removed  by  hydrochloric  acid. 
Wood  charcoal  is  prepared  by  burning  soft  wood  without  access  to  air. 

Charcoal  is  mentioned  here  because  of  its  deodorizing  power.  It 
has  the  peculiar  property  of  absorbing  many  times  its  own  volume  of 
gases  and  vapors.  It  is  not  used  much  in  dental  practice,  except  in  the 
laboratory  for  refining  metals.  When  well  ignited  it  will  deoxidize 
the  most  obdurate  metals.  Animal  charcoal  is  largely  used  by 
chemists  for  decolorizing  many  solutions  and  for  removing  coloring 
matter  from  alkaloids.  It  is  also  employed  as  a  filtering  medium  for 
purifying  drinking-water.  White  wood  ashes  were  formerly  used  for 
cleaning  teeth  by  the  laity.  Because  of  the  grittiness  of  the  particles,  it 
should  not  be  so  employed.  It  is  sometimes  internally  given  as  an 
absorbent  in  flatulent  dyspepsia.  Here  it  is  best  administered  in  the 
form  of  lozenges. 

CALENDULA— U.  S.  P. 
(Marigold.) 

Calendula  is  the  dried  ligulate  -florets  of  Calendula  officinalis, 
an   annual   plant,  indigenous  to  Southern  Europe  and  Levant,  fre- 


\KNICA — MVKKIIA.  57 

quently  cultivated  as  a  garden  ornament.  It  contains  a  bitter  princi- 
ple, calendulin,  and  a  trace  of  volatile  oil.  The  dose  is  from  5-30  gr. 
(0.3-2.0  gm.).     The  tincture  is  the  only  official  preparation: 

Tinctura  calcnduhe,  U.  S.  P.  (20  per  cent.).     Dose,  15-60  min. 
(1.0-4.0  c.c). 

Physiologic  Action  and  Therapeutics. — Calendula  has  a 
stimulating  action  upon  mucous  membranes,  and  is  used  chiefly  for 
its  local  influence.  It  acts  similar  to  arnica,  and  is  employed  for 
practically  the  same  conditions.  The  tincture  may  be  applied  to 
recent  wounds,  lacerated  gums,  open  sores,  etc.  It  hastens  the  healing 
of  wounds,  and  materially  aids  union  of  coapted  surfaces  by  first 
intention.  It  causes  a  scar,  or  cicatrix,  to  form  without  contraction  of 
tissue,  and  is  especially  useful  in  severe  bums. 

ARNICA— U.  S.  P. 

Arnica   is   the   dried   flowers   of    Arnica    montana,    a    perennial 

plant,  growing  in  temperate  regions  of  F.urope,  Asia,  and  America. 

It  contains  a  glucosid,  arnicin,  and  a  volatile  oil.     The  dose  is  about 

15   gr.    (i.o    gm.).     The   tincture   is    the    only    official    preparation: 

Tinctura  arnicae,  U.  S.  P.     Dose,  10-30  min.  (0.6-2.0  c.c). 

Physiologic  Action  and  Therapeutics. — The  action  of  arnica 
closely  resembles  that  of  calendula.  The  tincture  has  been  exten- 
sively used  as  a  stimulating  application  in  sprains  and  bruises.  Its 
antiseptic  power  is  doubtless  due  to  its  irritant  effect  upon  animal 
cells,  and  to  the  alcohol  which  the  tincture  contains. 

MYRRHA— U.  S.  P. 

(Myrrh.) 

Myrrh  is  a  gum-resin  obtained  from  commiphora  myrrha,  a 
small  tree  growing  in  Eastern  Africa  and  Arabia.  It  occurs  in  the 
form  of  brownish-red,  irregular-shaped  tears,  having  an  agreeable 
aromatic  odor  and  a  bitter  acrid  taste.  The  dose  is  about  5  gr. 
(0.3  gm.).     Its  official  preparations  and  those  into  which  it  enters  are: 

Tinctura  Mvrrh/e,  U.  S.  P.     Dose,  10-30  min.  (0.6-2.0  c.c). 

Tinctura  Aloes  et  Myrrhs,  U.  S.  P.  (10  per  cent,  of  each.). 

Dose,  \  to  2  fl.  dr.  (2.0-8.0  c.c). 

Mistura  Ferri  Composita,  U.  S.  P.  (Griffith's  Mixture).     Dose, 

1-4  fl.  dr.  (4.0-15.0  c.c). 

Piluke  Aloes  et  Myrrhs,  U.  S.  P.  (Aloes,  2  gr.-0.13  gm.;  Myrrh, 

1  gr.-o.06  gm.).     Dose,  1-4  pills. 

Piluke  Rhei  Compositae,  U.  S.  P.  (Aloes,  \  gr.-o.i  gm.;  Rhubarb. 

2  gr.-0.13  Kn1-'.  Myrrh,  1  gr.-0.06  gm.).     Dose,  1-5    pills. 


58  ANTISEPTICS,    DISINFECTANTS   AND    DEODORANTS. 

Physiologic  Action  and  Therapeutics. — Myrrh  is  a  stimulant 
to  mucous  membranes  and  acts  as  an  antiseptic  and  astringent.  The 
tincture,  diluted  with  water,  or  with  a  weak  solution  of  borax  or  potas- 
sium chlorate  has  been  extensively  used  as  a  local  application  in 
ptyalism,  ulcerative  stomatitis,  and  spongy  gums.  Water  added  to  the 
tincture  causes  a  milky  solution  on  account  of  the  resinous  constituent 
of  myrrh. 

OZONE  AND  OXYGEN. 

(03  and  O.) 

Ozone  is  an  allotropic  form  of  oxygen,  and  may  be  prepared 
from  the  latter  electrically.  It  occurs  in  the  air,  especially  after  an 
electrical  storm.  It  is  no  doubt  an  important  factor  in  the  antiseptic 
processes  of  nature,  and  has  been  used  to  some  extent  as  a  therapeutic 
agent  in  the  treatment  of  pyorrhea  alveolaris,  and  other  pathologic 
conditions;  but  its  practical  application,  as  yet,  has  not  been  fully 
demonstrated.  Oxygen  itself  is  used  extensively  in  nitrous  oxid, 
ether  and  chloroform  narcosis,  as  well  as  in  bronchitis,  anemia,  phthisis, 
and  the  later  stages  of  acute  pneumonia.  It  is  given  by  inhalation 
by  means  of  a  specially  devised  apparatus. 


PHENOL— U.  S.  P. 

(Phenol;  Carbolic  Acid;  C6H5OH.) 

Phenol  is  obtained  from  coal-tar  by  fractional  distillation.  It 
is  also  prepared  synthetically.  When  pure,  it  occurs  in  the  form  of 
colorless,  needle-shaped  crystals,  of  a  characteristic  odor  and  of  an 
acrid,  burning  taste.  On  exposure  to  damp  air  it  deliquesces,  and  the 
solution  exposed  to  light  gradually  acquires  a  reddish  tint.  It  is 
soluble  in  about  19.6  parts  of  water,  and  freely  in  alcohol,  glycerin, 
ether,  chloroform,  and  oils.  It  should  be  kept  in  dark  amber-colored 
bottles,  well-stoppered.  Although  it  was  official  up  to  1900  under 
the  name  Acidum  Carbolicum,  chemically  considered,  it  is  not  an 
acid,  but  an  alcohol  of  the  benzene  group.  The  dose  is  from  1/2-2  gr. 
(0.03-0.13  gm.). 

All  of  the  official  preparations  are  valuable  in  dental  practice. 
They  are: 

Phenol  Liquefactum,  U.  S.  P.  (contains  86.4  per  cent,  of  abso- 
lute Phenol  and  13.6  per  cent,  of  Water). 

Unguentum  Phenolis,  U.  S.  P.     Ointment  of  Phenol  (3  per  cent.). 
Glyceritum  Phenolis,  U.  S.  P.     Glycerite  of  Phenol  (20  per  cent.). 


PHENOL.  59 

Physiologic  Action. — Phenol  is  a  disinfectant,  as  it  destroys 
microorganisms.  Some  spore-bearing  forms,  however,  are  very 
resistant  to  its  action.  In  weak,  solutions  (2  per  cent.)  it  acts  as  an 
antiseptic.  Phenol  is  also  a  caustic  and  local  analgesic.  When 
applied  to  the  skin  or  mucous  membrane  it  blanches  the  surface  and 
causes  a  burning  sensation,  which  is  soon  followed  by  numbness. 
Later  the  part  becomes  red,  then  brown,  and  ultimately  desquamation 
takes  place.  Its  action  is  much  more  severe  on  mucous  membranes, 
and  should  be  used  about  the  mouth  with  caution.  Phenol  coag- 
ulates albumin,  therefore  its  caustic  action  is  limited,  and  does  not 
extend  deeply  into  the  tissues.  Absorption  of  the  drug  occurs  readily 
from  the  skin,  mucous  membranes,  and  wounds.  Its  prolonged 
use,  even  in  dilute  solutions  (2-5  per  cent.)  may  cause  gangrene  of 
the  parts. 

Poisoning  by  Phenol. — Poisoning  by  phenol  may  occur  either 
from  the  drug  being  taken  internally  or  from  its  external  appli- 
cation. It  is  a  poison  used  more  widely  for  suicidal  purposes,  perhaps, 
than  any  other.  Because  of  this  fact,  a  law  is  in  force  in  many  States 
of  the  Union  preventing  its  sale  to  the  laity  in  stronger  solutions 
than  33  1/3  per  cent.  The  dilution  being  made  with  alcohol  or 
glycerin. 

Toxic  doses  render  the  patient  rapidly  unconscious,  or  the  patient 
may  drop  dead  in  from  twelve  to  fifteen  minutes  after  taking  from 
respiratory  paralysis.  Butler  states  that  8.5  gm.  has  caused  the 
death  of  an  adult  in  fifteen  minutes.  One  and  one-half  grams  has 
caused  the  death  of  a  child  in  a  short  time.  If  the  dose  has  not  been 
sufficient  to  cause  respiratory  paralysis  in  so  short  a  time,  the  symp- 
toms are  those  of  gastroenteritis — intense  pain,  violent  vomiting  of 
white  slimy  mucus,  and  purging.  The  pupils  are  contracted,  stertorous 
breathing  appears,  with  cold,  clammy  skin,  pinched  face,  anxious 
expression,  a  rapid,  feeble  pulse,  and  finally  followed  by  unconscious- 
ness and  death  from  failure  of  respiration.  The  characteristic  phe- 
nomena are  the  odor  on  the  breath,  the  destruction  of  the  buccal 
mucous  membrane,  and  the  smoky  urine.  In  poisoning  from 
the  external  use  of  phenol  the  initial  symptoms  generally  are 
headache,  vertigo,  pallor,  muscular  weakness,  and  discoloration  of 
the  urine. 

Treatment  of  Poisoning. — When  the  poison  has  been  taken  by 
the  mouth  there  are  two  drugs  especially  indicated  in  the  treatment — 
alcohol  and  magnesium  sulphate  (Epsom  salt) .  The  alcohol  neutralizes 
the  caustic  action,  and  the  soluble  sulphate  forms  with  the  phenol  the 


60  ANTISEPTICS,    DISINFECTANTS    AND    DEODORANTS. 

innocuous  phenol  sulphonate.  Two  or  three  ounces  (60.0-90.0  c.c.) 
of  diluted  alcohol  should  be  poured  into  the  stomach  through  a  tube, 
followed  by  frequent  washing  out  of  the  stomach  with  „warm  water 
containing  magnesium  sulphate.  Warm  demulcent  drinks  are  useful 
in  allaying  the  irritation.  To  increase  the  efficiency  of  the  function 
of  the  heart  and  respiration,  strychnin  sulphate  and  atropin  sul- 
phate are  indicated.  For  the  relief  of  pain,  opium  or  its  alkaloids 
may  be  administered.  When  phenol  is  accidentally  or  otherwise  ap- 
plied to  the  skin  or  mucous  membrane,  its  caustic  action  can  be  pre- 
vented by  immediately  applying  alcohol  to^the  part. 

Therapeutics. — Phenol,  possessing  as  it  does  the  properties  of 
an  antiseptic,  disinfectant,  cauterant,  and  local  analgesic,  is  one  of 
the  most  useful  drugs  in  dental  practice.  As  a  disinfectant,  the  true 
value  of  the  drug  has  been  overestimated.  Its  great  affinity  for  al- 
bumin, which  it  quickly  and  firmly  coagulates,  prevents  any  penetra- 
tion beyond  the  superficial  layer  of  tissue  to  which  it  is  applied.  At 
best,  then,  it  is  but  a  surface  disinfectant.  A  1  per  cent,  solution  can 
be  employed  for  immersing  the  points  of  instruments  while  scaling 
the  teeth  in  pyorrheal  treatment.  Probably  the  only  objection  to  this 
solution  is  the  odor,  and  yet  patients  have  been  taught  that  any  solution 
possessing  the  odor  of  phenol  is  cleansing,  so  even  this'  objection 
loses  its  weight. 

The  drug  can  be  added  to  local  anesthetic  solutions  for  the  purpose 
of  keeping  the  latter  sterile.  Two  to  3  gr.  (o. '13-0. 15  gm.)  to  the  ounce 
(30.0  c.c.)  is  sufficient  to  prevent  the  growth  of  bacteria,  and  in  this 
strength  it  can  be  injected  into  the  tissue  without  any  appreciable 
coagulation  of  the  albumin. 

Its  local  analgesic  property  makes  it  a  valuable  remedy  for  desen- 
sitizing dentin,  to  apply  to  an  aching  pulp  in  the  early  stages  of 
pulpitis,  and  also  as  a  root-canal  dressing  after  the  removal  of  the  pulp 
tissue  by  either  the  anesthetization  or  devitalization  method.  It  has 
been  used  for  devitalizing  the  pulp  tissue  in  deciduous  teeth.  Its 
action  here  is  slow  and  unsatisfactory.  As  a  stimulating  agent  for 
cauterizing  sinuses  associated  with  dento-alveolar  abscesses  it  has  long 
been  used  with  success,  where  there  is  no  root  or  bone  complication. 
In  cases  of  painful  canker  sores  it  is  a  most  useful  remedy.  Applied 
full  strength  to  the  ulcerated  or  denuded  spot,  it  arrests  the  septic 
process,  and  the  coagulum  formed  serves  as  a  protection  to  the  exposed 
nerve-endings. 


CRESOL.  6l 

CRESOL- -U.   S.  P. 

CH3\ 
(Cresol;    'I  ricresol;  C6H4^ 

xOH  / 

Cresol,  formerly  commercially  called  tricresol,  is  a  refined  mixture 
of  three  isomeric  cresols  obtained  from  coal-tar,  freed  from  phenol, 
hydrocarbons,  and  water.  It  occurs  as  a  colorless  or  straw-colored 
refractive  liquid,  having  a  phenol-like  odor  and  a  burning,  caustic 
taste.  It  is  soluble  in  60  parts  of  water,  and  miscible  with  alcohol 
and  glycerin  in  all  proportions.  Cresol  is  sometimes  erroneously 
called  crecylic  acid.  It  is  not  an  acid,  but  is  methyl  phenol,  the  three 
isomeric  forms  being  known  chemically  as  ortho-,  meta-,  and  para- 
cresol.  On  exposure  to  light,  cresol  turns  to  a  yellowish-brown  color. 
It  should  be  kept  in  dark  amber-colored  bottles,  well-stoppered. 
The  dose  is  about  1  minim  (0.06  c.c).  The  official  liquor  cresol  is 
compositus  (compound  solution  of  cresol)  is  practically  identical  with 
the  commercial  preparation  known  as  lysol.  It  is  a  linseed-oil-soap 
solution  of  cresol,  50  per  cent,  in  strength. 

Lysol  (unofficial)  is  a  cresol  preparation  made  by  dissolving  in 
fat,  and  subsequently  saponifying  with  alcohol  that  portion  of  tar-oil 
which  boils  between  3470  and  3920  F.  (1900  and  2000  C).  It  con- 
tains 50  per  cent,  of  comparatively  pure  cresols.  It  is  a  brown,  oily 
liquid,  and  mixes  with  water  to  form  a  clear,  saponaceous,  frothy 
liquid. 

Physiologic  Action. —  Cresol  is  one  of  the  newer  preparations, 
and  its  action  is  almost  identical  with  that  of  phenol.  Some  authorities 
claim,  however,  that  cresol  is  more  toxic  to  bacteria  than  is  phenol, 
but  that  it  is  less  toxic  to  the  animal  cell  than  is  the  latter.  In  this 
respect  it  approaches  what  might  be  termed  an  ideal  disinfectant — an 
agent  which  will  kill  the  bacteria  without  acting  deleteriously  upon 
the  animal  cell,  but  cresol  is  too  toxic  to  the  animal  cell  to  be  so  consid- 
ered. Cresol  is  a  caustic,  though  somewhat  milder  in  action  than 
phenol,  and  it  possesses  marked  local  analgesic  properties. 

Therapeutics. — Cresol  is  a  disinfectant.  It  may  be  used  in 
dental  practice  with  equal  results  in  almost  every  condition  where 
phenol  is  indicated.  In  some  instances  it  is  greatly  superior  to  tin 
latter  drug.  Its  odor  may  be  considered  an  objection,  but  its  valuable 
properties  far  outweigh  this  slight  objection.  As  a  local  analgesic 
or  anodyne  for  root-canals  dressings  it  is  valuable,  and  can  be  used 
with  success  as  a  cauterizing  and  stimulating  agent  in  uncomplicated 


62  ANTISEPTICS,    DISINFECTANTS   AND    DEODORANTS. 

sinuses  associated  with  dento-alveolar  abscesses.  It  can  be  dissolved 
in  glycerin  or  alcohol,  with  both  of  which  it  is  miscible  in  all  propor- 
tions, and  the  solution  added  to  mouth-washes,  sprays,  and  other 
antiseptic  remedies.  A  i :  500  solution  may  be  used  as  a  vehicle  in 
which  to  dissolve  local  anesthetic  agents,  as  cocain  hydrochlorid.  Such 
solutions  remain  free  from  bacteria,  and  are  not  irritant  to  the  tissues  in 
which  they  are  injected.  It  is  a  constituent  of  the  author's  formo- 
cresol  remedy  which  is  an  absolute  specific  for  putrescent  pulp 
conditions. 

The  compound  solution  of  cresol  and  lysol  is  used  in  from  1  to  2 
per  cent,  solutions  in  surgical  work,  as  in  the  treatment  of  pyorrhea. 

CREOSOTUM— U.  S.  P. 

(Creosote.) 
Creosote  is  a  mixture  of  phenols  and  phenol  derivatives,  chiefly 
guaiacol  and  creosol,1  obtained  during  the  distillation  of  wood-tar,  pref- 
erably of  that  derived  from  the  beech.  It  is  almost  colorless,  or  a 
faintly  yellow,  oily  liquid,  having  a  penetrating,  smoky  odor,  and  a 
burning,  caustic  taste.  It  is  soluble  in  150  parts  of  water,  in  all  pro- 
portions in  alcohol,  ether,  chloroform,  and  oils.  It  seems  rather 
difficult  to  obtain  pure  beech-wood  creosote.  Much  of  the  creosote  on 
the  market  is  impure  phenol  (carbolic  acid).  Tests  for  the  purity  of 
the  drug  can  be  made  as  follows:  1.  Mix  equal  quantities  of  the  sus- 
pected specimen  and  collodion  in  a  clean,  dry  test-tube,  the  formation 
of  a  coagulum  will  indicate  the  presence  of  phenol.  2.  Mix  intimately 
equal  volumes  of  the  suspected  liquid  and  glycerin,  then  add  one  or 
more  volumes  of  water,  the  absence  of  turbidity  indicates  an  impure 
specimen  of  creosote.  The  dose  is  from  1-10  min.  (0.06-0.6  c.c). 
The  one  official  preparation,  aqua  creosoti,  is  not  much  used  in  den- 
tistry. As  stated  above,  the  chief  constituents  of  creosote  is  guaiacol 
and  creosol,  the  former  is  official. 

GUAIACOI^-U.  S.  P. 

Guaiacol  is  a  phenol  derivative  obtained  by  fractional  distilla- 
tion from  creosote.  It  is  a  colorless,  oily  liquid,  having  a  rather  un- 
pleasant aromatic  odor  and  taste.  It  is  sparingly  soluble  in  water, 
freely  so  in  alcohol  and  ether.  The  dose  is  from  1-3  min. 
(0.06-0.2  c.c). 

Physiologic  Action. — Like  all  members  of  the  phenol  groups, 
creosote  is  an  antiseptic,  disinfectant,  caustic  and  local  analgesic.     Its 


FORMALDEHYDUM.  63 

action  closely  resembles  that  of  phenol,  but  it  is  less  irritant  and 
toxic. 

Therapeutics. — Creosote  is  employed  in  dental  practice  chiefly 
as  a  disinfectant  and  local  analgesic.  It  is  probably  used  more  be- 
cause of  its  analgesic  property  than  any  other.  Creosote  mixed  with 
an  equal  volume  of  liquor  formaldehyd,  to  which  a  small  quantity 
of  alcohol  (20  min.  to  the  ounce — 1.3-30.0  c.c.)  is  added,  makes  an 
excellent  remedy  for  the  treatment  of  putrescent  pidp  conditions.  Equal 
volumes  of  creosote  and  tincture  of  iodin  has  long  been  employed  as  a 
local  analgesic  and  stimulant  in  apical  pericementitis.  Care  must  be 
taken  to  prevent  the  remedy  from  staining- the  dentin  of  the  crown  of 
the  tooth,  causing  discoloration.  Creosote  is  largely  used  as  a  tooth- 
ache remedy  by  the  laity.  Guaiacol  is  not  much  used  in  dentistry,  but 
is  used  in  medicine  in  pulmonary  tuberculosis  as  a  substitute  for 
creosote. 


FORMALDEHYDUM— U.  S.  P.     . 

(Formaldehyd;  Formic  Aldehyd;  CH20.) 

Formaldehyd  is  a  colorless  gas  having  a  very  pungent  odor, 
obtained  by  the  partial  oxidation  of  methyl  alcohol  (wood-alcohol). 
The  pharmacopeia  recognizes  a  37  per  cent,  aqueous  solution  of  the 
gas  under  the  name  liquor  formaldehydi — solution  of  formaldehyd. 
Various  solutions  of  the  gas  are  on  the  market,  commercially  called 
formalin,  formal,  etc.  The  gas  in  solution  readily  undergoes  poly- 
merization, whereby  a  solid  form  is  obtained,  known  as  paraformal- 
dehyde or  paraform  (CH203).  This  is  a  white  crystalline  powder, 
which  yields  formaldehyd  on  heating. 

Physiologic  Action. — Formaldehyd  is  one  of  the  best  disinfect- 
ants. Stevens  states  that  a  1  per  cent,  solution  of  liquor  formaldehyd 
kills  pure  cultures  of  pathogenic  bacteria  in  an  hour.  It  is  a  powerful 
deodorizer,  readily  uniting  with  hydrogen  sulphid,  mercaptan, 
ptomains,  ammonia,  and  fetid  ammonia  bases  to  form  inodorous 
compounds. 

The  gas  is  intensely  irritating,  when  inhaled  it  causes  severe 
hyperemia  and  even  inflammation  of  the  mucous  membrane  of  the 
entire  respiratory  tract.  Concentrated  solutions  will  produce  a  slough 
almost  as  readily  as  arsenic  trioxid. 

The  antidote  for  formaldehyd  poisoning  is  ammonia,  with  which 
it  forms  the  harmless  hexamethylenamin  (urotropin). 

Therapeutics. — Because    of    the    power    formaldehyd    has    for 


64  ANTISEPTICS,    DISINFECTANTS   AND    DEODORANTS. 

uniting  with  the  intermediate  and  end-products  of  pulp  decomposition, 
forming  with  them  nonpoisonous  substances  and  converting  the  gases 
into  liquids  and  solids,  it  is  a  most  essential  constituent  of  putrescent 
pulp  remedies.  Its  irritating  action  can  be  controlled  by  mixing  the 
official  liquor  formaldehyd  with  cresol,  phenol,  or  creosote.  The 
author's  formocresol  remedy  is  equal  volumes  of  cresol  and  liquor 
formaldehyd.  When  used,  this  remedy  should  always  be  hermetically 
sealed  within  the  tooth. 

A  10  per  cent,  solution  of  liquor  formaldehyd,  to  which  2  per  cent, 
of  borax  or  sodium  carbonate  is  added,  makes  an  excellent  sterilizing 
fluid  for  small  instruments.  The  alkaline  salt  (borax  or  sodium  car- 
bonate) prevents  the  formaldehyd  from  attacking  the  metal.  In 
weak  solutions  (1:1000  to  1:500)  it  may  be  added  to  mouth-washes 
and  sprays.  Apparatuses  are  on  the  market  for  using  paraform  for 
sterilizing  instruments.  Probably  the  only  objection  to  this  method 
is  the  liability  of  the  gas  escaping  in  the  office. 

In  medicine  formaldehyd  is  extensively  employed  as  a  surface 
disinfectant  for  rooms  containing  the  germs  of  contagious  diseases. 
Both  the  aqueous  solutions  and  the  solid  paraform  are  used  for  this 
purpose. 

Incompatibilities. — Formaldehyd  is  incompatible  with  ammo- 
nia, alkalies,  tannic  acid,  and  mineral  salts. 

HEXAMETHYLENAMINA— U.  S.  P. 

(Hexamethylenamin;  Urotropin.) 

Hexamethylenamin,  or  urotropin,  is  the  product  formed  by  the 
action  of  formaldehyd  on  ammonia.  It  is  not  used  in  dental  practice, 
but  mentioned  here  because  of  its  formation  within  the  tubular  struc- 
ture of  the  dentin  when  formaldehyd  gas  is  sealed  within  a  putrescent 
root  canal. 

AQUA  HYDROGENII  DIOXIDI— U.  S.  P. 

(Solution  of  Hydrogen  Dioxid;  H202.) 

Hydrogen  dioxid  is  a  very  unstable  compound,  prepared  by  the 
action  of  mineral  acids  (usually  sulphuric  acid)  on  barium  dioxid. 
The  official  aqueous  solution  should  contain,  when  freshly  prepared, 
about  3  per  cent,  by  weight  of  absolute  hydrogen  dioxid,  which  corre- 
sponds to  about  10  volumes  of  available  oxygen.  The  solution  is 
a  colorless  liquid,  without  odor,  slightly  acidulous  to  the  taste,  and  pro- 


AQUA    HYDROGENII    DIOXIDI.  65 

during  a  peculiar  sensation  and  a  soapy  froth  in  the  mouth.  It  is 
liable  to  deteriorate  with  age  or  by  exposure  to  heat  or  protracted 
agitation.  The  dose  is  from  1-4  fl.  dr.  (4.0-15.0  c.c),  well  diluted 
with  water. 

There  is  an  unofficial  ethereal  solution  of  hydrogen  dioxid  on  the 
market  which  contains  25  per  cent,  of  the  drug. 

Physiologic  Action. — When  hydrogen  dioxid  is  applied  to 
mucous  membranes  it  decomposes  into  water  and  oxygen,  the  latter 
being  given  off  in  large  quantities.  The  oxygen  thus  liberated  is  in 
the  nascent  state  and  readily  oxidizes  surrounding  substances.  Ap- 
plied to  suppurating  wounds  or  abraded  surfaces,  effervescence  fol- 
lows from  the  free  oxygen.  This  effervescence  is  not  necessarily  an 
indication  of  the  presence  of  infection  or  pus,  as  hydrogen  dioxid  will 
produce  effervescence  when  in  contact  with  blood.  Hydrogen  dioxid, 
because  of  the  liberation  of  nascent  oxygen,  destroys  healthy  granu- 
lations in  healing  wounds  and  should  therefore  be  employed  with 
caution,  if  used  at  all.  It  may  cause  sudden  death  when  injected 
hypodermically  or  intravenously  by  the  formation  of  gaseous  emboli 
in  a  blood-vessel. 

Therapeutics. — As  a  cleansing  agent  and  disinfectant,  hydrogen 
dioxid  has  been  extensively  applied  to  diseased  surfaces,  such  as 
canker  sores  and  other  ulcers,  pyorrheal  pockets,  sinuses,  etc.  In  diluted 
solution  it  has  been  much  used  as  an  antiseptic  remedy  in  many  diseases 
of  the  mouth,  throat,  and  nose.  The  drug  may  be  used  as  a  gargle  or 
spray,  or  applied  with  a  syringe  or  a  swab.  The  value  of  hydrogen 
dioxid  as  a  therapeutic  agent  depends  upon  the  readiness  with  which 
it  liberates  oxygen  when  it  is  brought  in  contact  with  abraded  tissues 
and  with  the  fluids  of  the  body.  It  should  therefore  be  used  with  great 
caution  in  all  practically  closed  sinuses  and  on  granulating  surfaces. 
While  the  drug  has  its  use  in  dental  practice,  its  real  value  has  been 
overestimated,  and  much  harm  has  resulted  from  its  injudicious  employ- 
ment. It  is  used  for  moistening  pumice  in  prophylactic  work;  the 
only  objection  to  its  employment  here  is  that  the  agent  causes  effer- 
vescence and  hides  the  field  of  operation.  As  a  cleansing  and  whiten- 
ing agent  for  the  teeth,  it  is  used  by  the  laity,  but  its  continued  use  as 
a  mouth-wash  is  likely  to  affect  deleteriously  the  tooth-structure,  on 
account  of  the  uncombined  sulphuric  acid  it  contains.  This  latter 
agent  seems  necessary  to  preserve  the  solution,  and  is  added  by  manu- 
facturers. As  a  bleaching  agent  it  is  of  great  value.  The  preparation 
mostly  used  for  bleaching  tooth-structure  is  the  25  per  cent,  ethereal 
solution. 

5 


66  ANTISEPTICS,    DISINFECTANTS   AND    DEODORANTS. 

POTASSII  PERMANGANAS— U.  S.  P. 

(Potassium  Permanganate;  KMn04.) 

Potassium  permanganate  occurs  in  the  form  of  slender,  dark- 
purple  prisms,  odorless,  and  of  a  sweetish,  astringent  taste.  It  is  solu- 
ble in  1 6  parts  of  water,  and  is  decomposed  by  alcohol  and  hydrogen 
dioxid.  It  should  be  kept  in  glass-stoppered  bottles,  protected  from 
light,  and  care  should  be  taken  not  to  bring  it  in  contact  with  organic 
or  readily  oxidizable  substances.  The  dose  is  from  1/2-2  gr.  (0.03- 
0.12  gm.). 

Physiologic  Action. — In  the  presence  of  organic  matter  potas- 
sium permanganate  quickly  yields  its  oxygen;  hence  it  is  a  good  disin- 
fectant and  deodorant.  Its  usefulness,  however,  is  limited,  for  when 
its  oxygen  is  given  up  it  is  rendered  inert. 

Therapeutics. — Its  readiness  to  part  with  oxygen  renders  it  of 
great  value  as  a  deodorant,  and  in  dilute  solutions,  1-5  gr.  (0.06-0.32 
gm.)  to  1  ounce  (30.0  c.c.)  of  water,  it  is  a  useful  remedy  in  thrush, 
foul  ulcers,  putrid  sore  throat,  syphilitic  chancre,  and  cancer  of  the 
tongue. 

It  is  employed  in  surgical  practice  for  disinfecting  the  hands, 
and  should  be  followed  with  a  saturated  solution  of  oxalic  acid  to 
remove  the  stain.  Its  disadvantage  for  use  in  the  mouth  is  its  tend- 
ency to  discolor  the  enamel  of  the  teeth.  This  is  only  a  surface  and 
therefore  temporary  discoloration. 

Incompatibilities. — Potassium  permanganate  is  incompatible 
with  organic  substances,  alcohol,  and  hydrogen  dioxid. 


CHINOSOL. 

Chinosol  occurs  as  a  yellowish,  crystalline  powder,  having  a  slight 
odor  and  a  very  disagreeable  taste;  soluble  in  water,  but  insoluble  in 
alcohol  and  ether.     It  is  used  externally. 

Physiologic  Action  and  Therapeutics. — Chinosol  is  a  chemic 
disinfectant.  Cook  and  Mawhinney  speak  highly  of  the  drug  as  a 
pus-destroyer,  recommending  its  free  use  in  from  1  to  10  per 
cent,  solutions  in  foul,  chronic  abscesses  and  all  other  violent 
suppurations.  The  objections  for  using  it  in  the  mouth  are:  It 
corrodes  steel  instruments;  discolors  tooth  structure;  -  and  has  a 
very  disagreeable  taste.  Cook  recommends  saccharin  to  overcome 
the  taste. 


KRESAMIN.  67 

KRESAMIN. 
(Ethylcnediamin  Tricresol.) 

Kresamin  is  a  clear,  colorless  liquid,  miscible  in  all  proportions 
with  glycerin,  and  soluble  in  5  parts  of  water.  It  is  only  used 
externally. 

Physiologic  Action  and  Therapeutics. — Kresamin  is  a  power- 
ful disinfectant,  with  a  claimed  minimum  toxicity.  It  is  said  that  the 
bactericidal  effect  of  the  cresol  and  its  power  of  penetrating  animal 
tissue  with  less  irritation  are  greatly  enhanced  by  the  presence  of 
ethylenediamin.  Mawhinney  speaks  of  using  it  in  cases  of  apical 
pericementitis,  chronic  alveolar  abscess,  and  all  inflammations  accom- 
panied with  pus  formation. 

HYDRARGYRI  CHLORIDUM  CORROSIOUM— U.  S.  P. 

While  mercuric  chlorid  will  be  discussed  with  the  class  of 
alteratives  under  Mercury  and  its  Compounds  (see  p.  187),  the  class  of 
disinfectants  would  indeed  be  incomplete  without  the  mention  of  this 
important  and  valuable  drug. 

Mercuric  chlorid  is  the  most  popular  of  all  the  disinfectants  for 
surgical  work.  The  drug  is  cheap,  soluble,  and  attacks  bacteria  and 
their  by-products  with  energy.  However,  there  are  three  principal 
objections  to  its  employment:  It  is  extremely  poisonous;  it  attacks 
metallic  instruments  detrimentally;  and  it  readily  acts  upon  albuminous 
matter,  rendering  the  drug  inert.  Stevens  claims  this  last  objection 
may  be  eliminated  by  adding  to  its  solution  a  weak  acid  (tartaric  or 
citric  acid).     . 

Heat  is  a  valuable  disinfectant,  and  without  doubt  is  the  most 
reliable  for  sterilizing  instruments.  All  known  pathogenic  bacteria 
and  their  spores  are  destroyed  by  heat.  The  author's  method  of 
sterilizing  operative  and  surgical  instruments  is  to  immerse  them  in 
boiling  water  for  from  2  to  3  minutes,  then  dip  them  in  a  10  per  cent, 
formaldehyd  solution  to  which  borax  has  been  added,  after  which  they 
are  again   transferred  to  the  boiling  water  and  carefully  dried  (see 

P-  375)- 

ASTRINGENTS,  STYPTICS,  AND  HEMOSTATICS. 

Astringents  are  agents  which  produce  contraction  and  condensa- 
tion of  tissue.  Styptics  and  hemostatics  apply  to  agents  that  arrest 
hemorrhage.  When  the  agent  is  applied  locally  it  is  called  a  styptic; 
when  administered  internally  it  is  called  a  hemostatic.     Many  of  the 


68  ASTRINGENTS,    STYPTICS,    AND    HEMOSTATICS. 

styptic  and  hemostatic  agents  control  hemorrhage  by  virtue  of  their 
astringent  property,  for  which  reason  these  classes  of  remedies  are  dis- 
cussed here  conjointly.  Astringent  agents  exert  their  influence  most 
markedly  when  applied  upon  raw  surfaces  and  mucous  membranes. 
Many  of  them  also  have  the  property  of  diminishing  or  arresting 
glandular  secretion.  This  result  is  produced  more  by  the  direct  action 
of  the  agent  upon  the  secreting  cell  than  it  is  by  the  constriction  of  the 
blood-vessels  of  the  part.  Cook,  in  his  experiments  upon  dogs,  has 
shown  that  mouth-washes  which  contain  astringent  agents,  notably 
zinc  chlorid,  arrest  the  secretion  of  ptyalin  for  a  considerable  number 
of  hours  after  the  solution  is  employed. 

Most  of  the  astringents  are  also  irritants,  especially  is  this  true  of 
some  of  the  metallic  salts,  the  action  of  which  is  more  irritant  and 
caustic  than  it  is  astringent.  This  is  largely  due  to  the  liberation  of  an 
acid  by  the  union  of  the  metal  with  the  albumin  of  the  cells. 

Astringents  may  be  conveniently  divided  into  two  classes,  vegetable 
and  mineral.  The  efficacy  of  those  of  vegetable  origin  depends  upon 
the  tannic  acid  which  they  contain.  It  should  be  remembered  that 
among  the  mineral  astringents,  bismuth  subnitrate,  zinc  oxid,  and  lead 
acetate  have  more  of  a  sedative  than  an  irritant  action.  The  vegetable 
astringents  of  importance  are: 

Tannic  acid.  Ergot. 

Gallic  Acid.  Krameria. 

Hematoxylin.  Hamamelis. 
Hydrastis. 

The  important  mineral  astringents  are: 

Alum.  Zinc  Oxid. 

Lead  Acetate.  Zinc  Iodid. 

Copper  Sulphate.  Zinc  Chlorid. 

Zinc  Sulphate.  Calcium  Chlorid. 

Zinc  Phenolsulphonate.  Bismuth  Subnitrate. 
Silver  Compounds. 

ACIDUM  TANNICUM— U.  S.  P. 

(Tannic  Acid;  Tannin;  HCI4HyOg.) 
Tannic  acid  is  the  active  constituent  of  all  vegetable  astringents. 
Its  chief  source  is  from  nutgall.  It  occurs  in  the  form  of  a  light- 
yellowish,  amorphous  powder,  odorless,  and  of  a  strongly  astringent 
taste.  Soluble  in  about  0.34  part  of  water  and  in  0.23  part  of 
alcohol;  also  soluble  in  about  1  part  of  glycerin  with  the  aid  of  moderate 
heat.     The  dose  is  from  3-10  gr.   (0.2-0.6  gm.). 


ACIDUM    TANNICUM.  69 

All  of  the  official  preparations  are  valuable  astringent  remedies. 
They  are: 

Collodium  Styptirum,  Styptic  Collodion  (20  per  cent.). 

Glyceritum  Acidi  Tannici,  Glycerite  of  Tannic  Acid  (20  per  cent.) . 

Unguentum  Acidi  Tannici,   Ointment  of  Tannic  Acid  (20  per 

cent.). 

Trochisci  Acidi  Tannici,  Troches  of  Tannic  Acid  (1  gr.-0.06  gm. 

in  each). 

Physiologic  Action. — Tannic  acid,  especially  when  applied  to 
raw  surfaces,  coagulates  the  albumin  of  the  superficial  cells,  causing 
condensation  of  the  tissue,  which  is  evidenced  by  the  sensation  of  puck- 
ering. On  mucous  membranes  it  acts  in  a  similar  manner,  combining 
with  the  proteids  of  the  glandular  cells,  thus  drying  up  the  secretion. 
It  also  paralyzes  the  sensory  nerve-endings  and  blunts  the  sense  of 
taste.  It  may  be  considered  a  styptic,  as  it  coagulates  the  albumin 
of  the  blood  and  checks  hemorrhage.  When  administered  internally, 
•tannic  acid  is  changed  in  the  intestine  into  gallic  acid,  and  in  this  form 
a  certain  amount  is  absorbed  and  eliminated  in  the  urine,  and  acts  as 
a  hemostatic. 

Therapeutics. — Tannic  acid  is  a  valuable  astringent  drug.  It 
may  be  applied  locally  in  the  form  of  the  glycerite  in  cases  of  spongy 
gums,  or  the  glycerite  may  be  added  to  mouth- washes  to  the  extent  of 
from  2  to  5  per  cent.,  thus  giving  to  the  solution  an  astringent  property. 
For  years  the  glycerite  was  applied  to  the  pulp  tissue  after  devitaliza- 
tion for  the  purpose  of  toughening  the  tissue  and  aiding  in  its  subsequent 
removal  from  the  canals  of  teeth,  but  its  liability  to  discolor  the  tooth- 
structure  when  so  used  constitutes  a  serious  objection  to  its  employ- 
ment (see  p.  287). 

A  solution  of  from  1/2  to  i  per  cent,  is  a  useful  remedy  to  be  used 
as  a  spray  or  gargle  in  cases  of  stomatitis,  laryngitis,  and  pharyngitis. 
Many  dentists  are  troubled  with  hyperidrosis  0}  the  hands.  Lotions 
containing  tannic  acids  are  often  beneficial  in  this  condition.  Dusting- 
powders,  as  well  as  lotions,  are  also  used  in  hyperidrosis  of  the  feet. 

Styptic  collodion  serves  as  a  protection  to  lacerated  or  incised 
wounds.  Troches  of  tannic  acid  may  be  dissolved  in  the  mouth  with 
benefit  in  cases  of  sore  throat. 

Incompatibility. — Tannic  acid  is  incompatible  with  alkaloids, 
gelatin,  lime-water,  the  salts  of  iron,  silver,  lead,  and  copper.  When 
potassium  chlorate  is  triturated  with  tannic  acid  or  organic  drugs 
containing  the  latter,  the  mixture  is  liable  to  explode. 


70  ASTRINGENTS,    STYPTICS,    AND    HEMOSTATICS. 

ACIDUM   GALLICUM. 

(Gallic  Acid;  HC7HsOs+H20.) 

Gallic  acid  is  prepared  generally  from  tannic  acid.  It  occurs 
as  white  or  pale  fawn-colored,  silky  needles,  odorless,  having  an  as- 
tringent or  slightly  acidulous  taste.  It  is  soluble  in  about  85  parts 
of  water,  in  4  parts  of  alcohol,  and  in  12  parts  of  glycerin.  The 
dose  is  from  5-20  gr.  (0.3-1.3  gm.),  given  in  powders  or  capsules. 

Physiologic  Action. — Gallic  acid  resembles  tannic  acid  when 
administered  internally;  but,  applied  locally,  it  is  a  very  feeble  astrin- 
gent, as  it  does  not  coagulate  albumin  and  hence  does  not  influence 
the  tissue  like  tannic  acid. 

Therapeutics. — About  the  only  indication  for  gallic  acid  in  dental 
practice  is  in  cases  of  hemorrhage  following  extraction.  Here  it  would 
be  employed  purely  as  a  hemostatic,  and  its  action  as  such  is  question- 
able, except  in  intestinal  hemorrhage. 


KRAMERIA— U.  S.  P. 

(Krameria;  Rhatany.) 

Krameria  is  the  dried  root  of  krameria  triandra,  a  low  shrub 
growing  in  the  sandy  localities  in  the  mountains  of  Bolivia  and  Peru. 
Tannic  acid  is  the  chief  constituent.  The  following  official  prepara- 
tions are  of  value  in  dentistry: 

Extractum  Krameriae.     Dose,  5-10  gr.  (0.3-0.6  gm.). 
Fluidextractum  Krameriae.     Dose,  5-30  min.  (0.3-2.0  c.c). 
Syrupus  Krameriae.     Dose,  1-2  fl.  dr.  (4.0-8.0  c.c). 
Tinctura  Kramerias.     Dose,  \-2  fl.  dr.  (2.0-8.0  c.c). 
Trochisci  Krameriae.     Dose,  1-5  troches  (each  contains  1  gr.-0.06 
gm.  of  the  extract). 


Physiologic  Action. — The  action  of  krameria  is  identical  with 
that  of  its  chief  constituent,  tannic  acid. 

Therapeutics. — The  astringency  of  the  drug  is  due  entirely  to 
the  tannic  acid  which  it  contains  in  large  amount.  It  has  no  special 
advantage  over  tannic  acid.  The  various  preparations  of  krameria, 
especially  the  tincture,  may  be  added  to  mouth-washes  and  gargles 
to  be  used  in  cases  of  rubber  sore  mouth,  spongy  gums,  ptyalism,  and 
pharyngitis.     The  troches  are  also  useful  in  sore  throat. 


HAMAMELIS — H^MATOXVLON — ERGOTA.  7 1 

HAMAMELIS. 

(Witch-hazel.) 

Hamamelis  is  official  as  the  bark  and  dried  leaves  of  hamamelis 
virginiana,  a  shrub  growing  in  the  damp  woods  of  North  America. 
It  contains  a  volatile  oil,  a  small  amount  of  tannic  acid,  and  a  bitter 
principle.     The  official  preparations  are: 

Aqua  Hamamelidis,  U.  S.  P.  Dose,  1-4  fl.  dr.  (4.0-15.0C.C.). 
Fluidextractum  Hamamelidis  Foliorum,  U.  S.  P.  Dose,  1/2-1 
fl.  dr.  (2.0-4.0  c.c). 

Physiologic  Action. — The  action  of  hamamelis  is  that  of  an 
astringent,  due  largely  to  the  tannic  acid  it  contains.  Besides  its 
astringent  property,  the  drug  is  credited  with  having  a  marked  sedative 
effect  when  topically  applied. 

Therapeutics. — Preparations  of  hamamelis  are  useful  house- 
hold remedies.  As  a  topical  application  after  shaving,  and  for  sprains 
and  bruises  hamamelis  water  has  long  enjoyed  a  popular  reputation. 
Diluted  with  water,  alcohol,  or  glycerin  (i  part  to  3),  the  distilled  extract 
may  be  used  as  a  spray  in  inflamed  and  spongy  gums,  pharyngitis, 
and  applied  to  the  nasal  mucous  membrane  after  the  removal  of 
polypi. 

Hamamelis  water  has  been  recommended  to  be  diluted  one-half 
with  distilled  water  and  used  as  a  vehicle  for  local  anesthetic  solutions. 
It  should  not  be  so  employed,  as  the  tannic  acid  will  act  upon  the  alka- 
loidal  salt  (usually  cocain  hydrochlorid)  and  precipitate  the  alkaloid. 

HiEMATOXYLON— U.  S.  P. 

(Logwood.) 

Hematoxylon  is  the  heart-wood  of  Hamatoxylon  campechianum, 
a  rather  small  tree  growing  along  the  shores  of  the  Gulf  of  Cam- 
peachy  and  in  certain  parts  of  South  America.  Besides  tannic  acid 
it  contains  a  crystalline  coloring  principle,  hematoxylin.  There  is  only 
one  official  preparation: 

Extractum  haematoxyli,  U.  S.  P.     Dose,  5-30  gr.  (0.3-2.0  gm.). 

The  drug  has  no  dental  use  except  as  a  staining  agent  for  tissues 
in  microscopic  study,  for  which  purpose  it  is  extensively  employed. 

ERGOTA— U.  S.  P. 

(Ergot;  Ergot  of  Rye.) 

Ergot  is  the  sclerotium  of  Claviceps  purpurea,  a  parasitic  fungus, 
which  replaces  the  grain  0}  rye,  Secale  cereale.     Ergot  is  obtained 


72  ASTRINGENTS,    STYPTICS,    AND    HEMOSTATICS. 

chiefly  from  the  rye  growing  in  Russia,  Spain,  and  Germany.     The 
following  preparations  are  official: 

Vinum  Ergotae,  U.  S.  P.     Dose,  1-4  fl.  dr.  (4.0-16.0  c.c). 
Fluidextractum     Ergotae,     U.    S.     P.      Dose,    1/2-1    fl.    dr. 
(2.0-4.0  c.c). 
Extractum  Ergotae,  U.  S.  P.     Dose,  5-15  gr.  (0.3-1.0  gm.). 

Physiologic  Action. — Ergot  has  no  local  action.  The  drug 
must  be  taken  internally  to  produce  its  effects.  When  it  enters  the 
circulation  it  acts  directly  upon  the  muscular  coats  of  the  vessels, 
causing  constriction  of  the  arterioles,  with  an  increase  in  arterial  pres- 
sure. The  involuntary  muscles  throughout  the  body  appear  to  be 
influenced  by  ergot;  the  voluntary  muscles  are  unaffected. 

Therapeutics. — Ergot  is  used  in  dentistry  for  its  hemostatic 
property.  In  cases  of  known  hemorrhagic  diathesis  (hemophilia), 
it  is  well  to  administer  the  drug  a  few  hours  previous  to  the  extraction 
of  teeth  or  other  operations  involving  hemorrhage.  The  fluid 
extract  is  the  most  reliable  preparation  and  may  be  given  in  doses  of 
1/2-1  fl.  dr.  (2.0-4.0  c.c). 

Ergot  should  not  be  given  when  the  hemorrhage  proceeds  from  a 
large  vessel,  because  here  the  muscular  contraction  could  not  close 
the  vessel,  and  the  increased  arterial  pressure,  occasioned  by  the  drug, 
would  naturally  increase  the  flow  of  blood. 

The  drug  should  not  be  given  to  pregnant  women,  because  of  the 
contraction  it  produces  on  the  unstriped  muscle  of  the  uterus.  Ergot 
is  the  one  drug  relied  upon  to  prevent  postpartum  hemorrhage  during 
and  following  labor  in  confinement  cases. 

HYDRASTIS— U.   S.  P. 

(Golden  Seal.)  . 

Hydrastis  is  the  dried  rhizome  and  roots  of  hydrastis  canadensis, 
a  perennial  herb  growing  in  the  woods  of  North  America.  One  of  the 
chief  constituents  is  hydras  tin,  which  is  official  under  the  title  Hydras- 
Una.     Other  constituents  are  berberin  and  canadin. 

The  official  preparations  of  hydrastis  are: 

Fluidextractum  Hydrastis,  U.  S.  P.     Dose,  1/2-1  fl.  dr.  (2.0-4.0  c.c.) 
Tinctura  Hydrastis,  U.  S.  P.     Dose,  1/2-2  fl.  dr.  (2.0-8.0  c.c). 
Glyceritum  Hydrastis,  U.  S.  P.     Externally. 

Physiologic  Action  and  Therapeutics. — The  action  of  hydrastis 
is  due  almost  entirely  to  the  presence  of  the  alkaloid,  hydrastin,  which 
it  contains.     Applied  locally,  it  appears  to  have  a  stimulating  influence 


GLANDULE   SUPRARENALES   SICC.l ..  73 

upon  the  oral  mucous  membrane.  The  glycerite  may  be  added  to 
mouth-washes  (5  per  cent.)  and  used  in  sluggish  conditions  of  the 
mucous  membranes,  as  in  chronic  catarrh,  etc.  The  drug  also  has 
astringent  and  antiseptic  properties.  The  fluid  extract  applied  to 
indolent  ulcers  stimulates  the  condition  to  a  healthy  activity.  In- 
ternally administered  it  acts  as  a  stomachic  and  is  a  constituent  of 
many  bitter  tonics. 

Incompatibles. — These  are  the  same  as  those  of  other  alkaloids. 


GLANDULE  SUPRARENALES  SICC.E—  U.  S.  P. 
(Desiccated  Suprarenal  Glands;  Suprarenal  Extract.) 

This  product  is  neither  a  vegetable  nor  mineral  astringent,  but  is 
considered  here  because  it  belongs  to  this  group.  It  is  the  glands  of  the 
sheep  or  ox,  freed  from  fat,  cleaned,  dried,  and  powdered;  one  part 
represents  approximately  6  parts  fat-free,  fresh  glands.  It  occurs  as  a 
light,  yellowish-brown  powder,  partially  soluble  in  water.  The  dose 
is  about  4  gr.  (0.25  gm.). 

The  active  principle  has  been  separated  by  different  men  and 
variously  named  epinephrin  (Abel),  suprarenin  (Von  Furth),  adrenalin 
(Takamine  and  Aldrich).  According  to  the  best  authorities,  the  last- 
named,  adrenalin,  represents  more  fully  the  active  properties  of  the 
gland.  It  occurs  as  a  white,  crystalline  substance.  It  dissolves  with 
difficulty  in  cold  water;  but  dissolves  readily  in  acids,  forming  salts. 
Solutions  of  adrenalin  chlorid  are  on  the  market  under  various  names, 
a.s  adrenalin,  adnepJirin.  suprarenalin,  etc. 

Physiologic  Action  and  Therapeutics. — Suprarenal  gland,  or 
solutions  of  its  active  principle,  acts  locally  on  a  variety  of  structures, 
probably  by  stimulating  the  sympathetic  nerve  terminals.  Its  most 
important  action  is  the  constriction  of  blood-vessels,  with  the  usual 
high  rise  of  blood  pressure.  The  drug  is  used  in  dentistry  largely  for 
its  hemostatic  properties.  It  should  be  remembered  that  the  solutions 
of  adrenalin  will  prevent  hemorrhage  if  used  before  operating  better 
than  it  will  check  the  hemorrhage  after  it  proceeds.  Prinz  and  others 
recommend  its  use  for  the  vasoconstrictor  action  to  intensify  and  pro- 
long the  anesthetic  effect  of  local  anesthetics  by  retarding  the  circula- 
tion in  the  affected  part  and  thus  hindering  the  dilution  of  the  anes- 
thetic agent  by  too  rapid  absorption  into  the  general  blood  stream. 
Solutions  of  adrenalin  chlorid  have  been  recommended  as  the  vehicle 
for  dissolving  cocain  hydrochlorid  in  the  removal  of  the  dental  pulp 


74  ASTRINGENTS,   STYPTICS,    AND  HEMOSTATICS. 

by  pressure  anesthesia.     Its  use  here,  however,  is  unwarranted  and 
objectionable  (see  Practical  Therapeutics,  p.  283). 

The  dilute  aqueous  solutions  are  rather  unstable,  the  deterioration 
being  accompanied  by  a  reddish  or  brownish  discoloration.  The 
drug  can  be  obtained  alone  or  combined  with  other  drugs,  in  tablet 
form.     The  powder  is  stable. 


GLANDULE  THYROIDE.E  SICC^— U.  S.  P. 

(Desiccated  Thyroid  Glands;  Thyroid  Extract.) 

This  product  is  the  glands  of  the  sheep  freed  from  fat,  cleaned, 
dried,  and  powdered.  One  part  representing  approximately  5  parts 
of  the  fresh  gland.  It  is  a  yellowish,  amorphous  powder,  partially 
soluble  in  water.  Dose,  about  4  gr.  (0.25  gm.).  The  product  is  not 
much  used  in  dentistry.  Its  general  properties  being  alterative, 
hemostatic,  and  antifat. 

ALUMEN— U.  S.  P. 

(Alum;  Aluminum  and  Potassium  Sulphate;  A12K2  (S0.4)%4  +  i2H20). 

The  alum  recognized  by  the  United  States  Pharmacopeia  is 
aluminum  and  potassium  sulphate.  This  is  what  is  known  in  chemistry 
as  a  double  sulphate.  It  occurs  in  large,  colorless,  octahedral  crystals, 
odorless,  but  having  a  sweetish  and  strongly  astringent  taste.  Soluble 
in  water  and  in  warm  glycerin,  insoluble  in  alcohol.  The  dose  is 
from  5-15  gr.  (0.3-1.0  gm.).  As  an  emetic  it  may  be  given  in  much 
larger  doses — 1-2  dr.  (4.0-8.0  gm.).  The  dried  or  burnt  alum  is  also 
official  under  the  title  Alumen  Exsiccatum,  U.  S.  P. 

Physiologic  Action.- — Alum  is  a  powerful  astringent  when  ap- 
plied to  the  broken  skin  or  mucous  membranes.  It  acts  by  coagulating 
the  albumin  of  the  superficial  cells,  thus  causing  condensation  of  the 
tissues.  With  the  blood  it  forms  a  firm  coagulum,  and  tends  to  arrest 
hemorrhage.  When  applied  to  the  unbroken  skin,  it  has  a  tendency 
to  thicken  and  harden  it. 

Therapeutics. — In  edentulous  mouths  alum  may  be  used  to 
toughen  the  mucous  membrane.  A  solution  of  from  5  to  10  gr. 
(0.3-0.6  gm.)  to  the  ounce  (30.0  c.c.)  is  a  useful  remedy  in  cases  of 
rubber  sore  mouth,  subacute  and  chronic  pharyngitis  and  laryngitis, 
especially  where  there  is  a  viscid  mucous  secretion.  It  has  a  destructive 
action  on  the  tooth-structure,  hence  its  prolonged  use  in  the  mouth  is 


PLUMBI   ACETAS.  75 

contraindicated,  except  in  edentulous  mouths.  It  may  be  used  as  a 
styptic  to  arrest  hemorrhage  from  small  wounds.  A  large  smooth 
crystal  may  be  moistened  and  applied  to  the  face  after  shaving,  as  the 
alum  thickens  and  toughens  the  unbroken  skin  and  also  tends  to  arrest 
any  small  hemorrhages  which  may  follow  the  operation.  Dried  alum 
may  be  employed  as  a  mild  caustic  for  indolent  ulcers  and  for  destroying 
exuberant  granulations,  as  are  often  seen  covering  the  fragment  of  a 
broken  tooth-root  a  few  days  after  an  unsuccessful  attempt  in 
extraction. 

Lotions  of  alum  and  dilute  alcohol  are  sometimes  employed  in 
hyperidrosis  of  the  hands  and  feet. 

Incompatibles. — Alum  is  incompatible  with  alkalies,  alkaline 
carbonates,  lead  acetate,  mercury,  iron  salts,  and  tannic  acid. 

PLUMBI  ACETAS— U.  S.  P. 

(Lead  Acetate;  Sugar  of  Lead;  Pb(C2H302)2 +3H20.) 

Lead  acetate  occurs  in  colorless,  shining,  transparent,  heavy 
prismatic  crystals  or  crystalline  masses,  having  a  faintly  acetous  odor 
and  a  sweetish,  metallic  taste.  It  is  soluble  in  2  parts  of  water  and  in 
30  parts  of  alcohol.     The  dose  is  from  1-5  gr.  (0.065-0.3  gm.). 

Physiologic  Action. — Metallic  lead  is  practically  inert,  and 
the  tissues  take  kindly  to  it.  A  clean  lead  bullet  may  become  encysted 
in  the  tissues.  Lead  acetate  has  valuable  therapeutic  properties. 
Applied  in  solution  to  denuded  or  highly  inflamed  surfaces,  its  action 
is  both  astringent  and  sedative.  In  the  mouth  it  acts  immediately, 
coagulating  the  mucus  and  producing  a  sweet,  styptic  taste.  When 
taken  internally  and  absorbed,  the  lead  enters  as  a  constituent  part 
into  the  protoplasm  of  the  cells,  and  is  exceedingly  slow  in  being 
eliminated.  Lead  poisoning  may  result  from  the  internal  administra- 
tion, but  the  cases  fortunately  are  rare,  for  the  acetate  is  an  emetic 
and  the  emesis  produced  prevents  toxic  effects  of  the  drug. 

Therapeutics. — Lead  acetate  is  not  much  employed  in  dental 
practice.  Its  sedative  as  well  as  its  astringent  properties  make  it  a 
useful  drug  to  be  applied  to  acute  inflammatory  conditions  of  all  mucous 
membranes.  In  cases  of  inflammation  following  the  removal  of  foreign 
substances  from  the  eye,  a  solution  of  lead  acetate,  1-2  gr.  (0.065-0.13 
gm.),  to  the  ounce  (30.0  c.c.)  of  distilled  water  makes  an  excellent 
collyrium.  Should  the  solution  be  turbid  or  milky,  it  indicates  a  trace 
of  lead  oxid.  The  smallest  amount  (1  min.)  of  dilute  acetic  acid 
will  clear  the  solution. 


76  ASTRINGENTS,   STYPTICS,   AND  HEMOSTATICS. 

CUPRI  SULPHAS— U.  S.  P. 

(Copper    Sulphate;    Blue   Vitriol;    CuSo4 +5H20.) 

Copper  sulphate  occurs  in  large,  transparent,  deep-blue  crystals, 
odorless,  and  of  ,a  nauseous  metallic  taste.  It  is  soluble  in  about  2.5 
parts  of  water,  and  almost  insoluble  in  alcohol.  The  dose  as  an 
astringent  is  from  1/4-1  gr.  (0.016-0.06  gm.);  as  an  emetic,  5-20  gr. 
(0.3-1.3  gm.). 

Physiologic  Action. — The  mode  of  action  of  copper  sulphate 
depends  largely  upon  the  strength  of  the  solution  employed.  Dilute 
solutions  act  upon  mucous  membranes  and  raw  surfaces  as  an  astringent. 
In  concentrated  solutions  or  applied  in  the  crystal  or  powdered  form, 
it  acts  as  a  mild  caustic.  Internally  administered  in  large  doses,  it 
produces  emesis  by  its  direct  irritant  action  on  the  stomach. 

Therapeutics. — Copper  sulphate  is  a  useful  drug  in  cases  of 
canker  sores,  ulcerative  stomatitis,  and  other  indolent  ulcers.  Light 
applications  of  the  solid  crystal  produces  a  stimulant  effect  upon  the 
sluggish  cells. 

It  is  a  prompt  and  powerful  emetic,  but  considered  too  irritant  to 
the  stomach  for  ordinary  use. 

Bevan  and  Brophy  report  good  results  with  copper  sulphate  in 
the  treatment  of  actinomycosis  occurring  in  man.  They  begin  with 
about  1/4  gr.  (0.016  gm.)  given  three  times  a  day,  gradually  increasing 
the  dose  to  1  gr.  (0.065  gm0-  In  addition  to  the  internal  adminis- 
tration of  the  drug,  irrigations  of  a  1  per  cent,  solution  are  also 
employed. 

CUPRI  OXIDUM— Unofficial. 

(Black  Copper  Oxid;  CuO.) 

Copper  oxid  occurs  as  a  heavy  dark-brown  powder;  insoluble 
in  water.  This  product  has  been  modified  by  Ames,  and  is  used  as 
the  powder  for  the  copper  phosphate  cement,  a  material  extensively 
employed  in  filling  cavities  in  children's  teeth.  This  cement  is  claimed 
to  possess  marked  antiseptic  properties  as  well  as  serving  the  function 
of  a  temporary  filling  material. 

ZINCI  SULPHAS— U.  S.  P. 

(Zinc  Sulphate;  White  Vitriol;  ZnS04  +  7H20.) 

Zinc  sulphate  occurs  in  colorless,  transparent  crystals,  or  granu- 
lar crystalline  powder,  odorless,  and  of  an  astringent  metallic  taste. 


ZINCI    PHENOLSULPHONAS.  77 

It  is  soluble  in  less  than  its  own  weight  (0.53  part)  in  water,  in  about 
3  parts  glycerin,  and  insoluble  in  alcohol.  It  is  rarely  given  internally 
except  as  an  emetic,  when  the  dose  is  from  10-30  gr.  (0.6-2.0  gm.). 

Physiologic  Action. — Zinc  sulphate  acts  as  an  astringent, 
styptic,  emetic,  and  antiseptic.  In  weak  solutions  it  is  astringent  and 
antiseptic;  in  strong  solutions  it  acts  as  an  irritant  or  caustic,  tending 
to  arrest  slight  hemorrhage  when  applied  externally  and,  when  admin- 
istered internally,  producing  emesis. 

Therapeutics. — Weak  solutions  of  zinc  sulphate  may  be  applied 
to  raw  surfaces  and  to  mucous  membranes  whenever  a  slight  astrin- 
gent effect  is  desired.  A  solution  of  from  1/2-2  gr.  (0.06-0.1  gm.) 
to  the  ounce  (30.0  c.c.)  is  a  valuable  collyrium  in  simple  conjunc- 
tivitis. A  1  per  cent,  solution  is  also  useful  in  ulcerative  stomatitis, 
cancrum  oris,  and  as  a  gargle  in  enlarged  tonsils  and  sore  throat. 

As  an  emetic  it  is  employed  in  narcotic  poisoning,  10-30  gr. 
(0.6-2.0  gm.)  dissolved  in  water  being  given,  and  repeated  in  fifteen 
to  twenty  minutes,  if  necessary. 

Incompatibles.— Zinc  sulphate  is  incompatible  with  alkalies, 
alkaline  carbonates,  vegetable  astringents,  lead  acetate,  silver  nitrate, 
and  lime-water. 

ZINCI  PHENOLSULPHONAS— U.  S.  P. 

(Zinc  Phenolsulphonate;  Zinc  Sulphocarbolate; 
Zn(C6H4(OH)S03)2.) 

Zinc  phenolsulphonate,  also  commonly,  though  erroneously, 
called  zinc  sulphocarbolate,  occurs  in  colorless,  transparent  prisms, 
or  tabular  crystals,  odorless,  and  having  an  astringent,  metallic  taste; 
on  exposure  to  air  and  light  it  effloresces  and  may  acquire  a  pink  tint. 
It  is  freely  soluble  in  water  and  alcohol.  The  aqueous  solution  is 
acid  to  litmus.  It  is  rarely  given  internally;  the  average  dose  is  2  gr. 
(0.125  gm.). 

Physiologic  Action. — Zinc  phenolsulphonate  is  an  astringent 
and  antiseptic,  and  produces  a  stimulant  effect  upon  mucous  mem- 
branes. It  acts  similar  to  other  zinc  salts,  but  the  contained  phenol 
radical  adds  to  its  antiseptic  power. 

Therapeutics. — This  salt  has  but  recently  been  employed  in 
dental  practice.  YYhitslar  suggests  the  use  of  a  10  per  cent,  solution 
in  cinnamon  water  as  a  stimulating  antiseptic  following  the  surgery 
of  pyorrhea  alveolaris.  1/2  dr.  (2.0  gm.)  added  to  8  oz.  (240.0  c.c.) 
of  liquor  antisepticus  makes  a  valuable  astringent  mouth-wash  to  be 
used  in  stomatitis  and  sore  throat. 


78  ASTRINGENTS,    STYPTICS,    AND    HEMOSTATICS. 

ZINCI  OXIDUM— U.  S.  P. 

(Zinc  Oxid;  ZnO.) 

Zinc  oxid  is  a  fine,  white,  amorphous  powder,  without  odor  or 
taste.  Insoluble  in  water  or  alcohol.  It  is  rarely  used  internally, 
an  average  dose  being  4  gr.  (0.25  gm.).  There  is  one  official  prep- 
aration: 

Unguentum  Zinci  Oxidi,  U.  S.  P.  (20  per  cent.). 

Physiologic  Action. — Zinc  oxid  is  a  mild  astringent  and 
antiseptic. 

Therapeutics. — -This  drug  is  used  extensively  as  a  vehicle  for 
making  pastes  of  liquids  for  treating  putrescent  pulps  and  dento-alveolar 
abscess  and  for  root-canal  fillings.  It  is  the  base  of  the  powder  for  all 
zinc  phosphate  cements. 

The  ointment  may  be  employed  to  soften  and  protect  the  mucous 
membrane  of  dry  and  cracked  lips  previous  to  operating  or  adjusting 
the  rubber  dam.  The  ointment  is  also  extensively  used  as  a  slightly 
astringent  and  protective  dressing  for  cold-sores,  burns,  acute  ulcers, 
and  acute  inflammatory  skin  diseases. 

ZINCI  IODIDUM— U.  S.  P. 

(Zinc  Iodid;  Znl2.) 

Zinc  iodid  is  a  white,  granular  powder,  without  odor,  and  having 
a  sharp,  saline,  and  metallic  taste.  It  is  a  very  deliquescent  salt  and 
liable  to  absorb  oxygen  from  the  air,  becoming  brown  from  liberated 
iodin.  Readily  soluble  in  water,  alcohol,  or  ether.  It  should  be  kept 
in  glass-stoppered  bottles.  When  used  internally  the  dose  is  1/2-1  gf. 
(0.03-0.06  gm.). 

Physiologic  Action. — Zinc  iodid  is  astringent,  antiseptic,  and 
alterative. 

Therapeutics. — This  salt  may  be  used  as  a  mild  astringent,  anti- 
septic and  alterative  in  cases  of  ulcerative  stomatitis  and  pyorrhea 
alveolaris.  Talbot  suggests  using  the  following  remedy  in  cases  of 
flabby  and  inflamed  gums:  Zinc  iodid  15  parts,  water  10  parts,  iodin 
25  parts,  and  glycerin  40  parts.  The  salt  can  also  be  added  to 
mouth-washes  to  give  astringency  to  the  solution. 

ZINCI  CHLORIDUM— U.   S.  P. 

(Zinc  Chlorid;  ZnCl2.) 
Zinc  chlorid  occurs  as  a  white,  granular  powder,  or  fused  mass, 
very  deliquescent,  odorless,  and  of  a  caustic  metallic  taste.     Freely 


CALCII    CHLORIDUM.  79 

soluble  in  water  and  alcohol.     It  is  not  used  internally.     The  official 
preparation  is: 

Liquor  Zinci  Chloridi,  U.  S.  P.  (50  per  cent.). 

Physiologic  Action. — Zinc  chlorid  is  feebly  astringent  and 
antiseptic.  It  is  the  most  caustic  of  all  the  zinc  salts,  and  possesses 
marked  styptic  properties.  Its  prolonged  use  in  the  mouth  interferes 
with  the  secretory  action  of  the  salivary  glands  (Cook). 

Therapeutics. — Various  strength  solutions  of  zinc  chlorid  have 
enjoyed  an  unmerited  reputation  as  a  disinfectant  in  dental  practice. 
For  years  the  saturated  solution  has  been  mixed  with  zinc  oxid  to  make 
a  paste,  so-called  zinc  oxychlorid  cement,  and  used  for  filling  root- 
canals.  A  10  per  cent,  solution  may  be  employed  for  arresting  profuse 
hemorrhage  in  pressure  anesthesia.  Applied  to  sensitive  dentin  it  acts 
as  an  obtundent.  Care  must  be  taken  not  to  use  it  in  deep-seated 
cavities  nearly  involving  the  pulp,  as  the  hydrochloric  acid  liberated 
will  irritate  the  pulpal  organ.  This  irritant  property  may  be  controlled 
by  dissolving  the  salt  in  alcohol  and  then  adding  chloroform.  A 
formula  for  sensitive  dentin  follows:  Zinc  chlorid  20  gr.  (1.3  gm.), 
alcohol  and  chloroform,  of  each,  1/2  fl.  oz.  (15.0  c.c).  The  drug  has 
been  recommended  to  be  added  to  mouth-washes  to  impart  astringency 
to  the  solution.  Its  value  here  has  been  overestimated,  for  it  is  the 
least  astringent  of  all  zinc  salts,  and  its  continued  use  in  the  mouth 
changes  temporarily  the  character  of  the  saliva. 


CALCII  CHLORIDUM— U.  S.  P. 

(Calcium  Chlorid;  CaCl2.) 

Calcium  chlorid  occurs  in  white,  rather  translucent,  hard  frag- 
ments, very  deliquescent,  odorless,  and  of  an  acrid  saline  taste.  It  is 
freely  soluble  in  water,  somewhat  less  so  in  alcohol.  The  dose  is  from 
5-20  gr.  (0.3-1.3  gm.). 

Physiologic  Action  and  Therapeutics. — Internally  administered 
calcium  chlorid  increases  the  coagulability  of  the  blood.  This  property 
was  first  mentioned  by  Wright,  of  England,  in  1893.  ^  has  been  used 
with  success  in  hemophilia,  and  in  small  persistent  hemorrhages,  like 
that  which  sometimes  follows  the  extraction  of  teeth. 

Wright  found  that  the  prolonged  administration  of  the  drug  rather 
decreases  than  increases  the  coagulability  of  the  blood,  and  that  it  acts 
best  as  a  hemostatic  by  giving  it  in  doses  of  from  3-10  gr.  (0.2-0.6  gm.) 


80  ASTRINGENTS,    STYPTICS,    AND    HEMOSTATICS. 

three  times  a  day,  for  a  period  of  two  or  three  days,  and  discontinuing 
its  use  for  a  like  period.  The  drug  is  very  irritating  to  the  stomach 
and  should  be  griven  after  meals,  well  diluted. 


BISMUTHI  SUBNITRAS— U.   S.  P. 

(Bismuth  Subnitrate;  BiON03  +H20(?).) 

Bismuth  subnitrate  is  a  heavy  white  powder,  of  a  somewhat  vary- 
ing chemic  composition,  odorless,  almost  tasteless,  and  permanent 
in  the  air.  It  is  insoluble  in  water  and  alcohol,  but  soluble  in  gly- 
cerin in  about  12  parts  (Hereth).  The  dose  is  from  5-40  gr. 
(0.3-2.6  gm.). 

Physiologic  Action. — Upon  the  unbroken  skin  bismuth  sub- 
nitrate simply  acts  as  a  protective  agent;  but  upon  raw  surfaces  and 
mucous  membranes  it  also  acts  as  an  astringent  and  antiseptic.  From 
denuded  surfaces  absorption  of  the  drug  takes,  place  rather  speedily, 
and  poisoning  has  been  known  to  occur  from  its  too  frequent  application. 
The  symptoms  of  bismuth  poisoning  are  stomatitis,  salivation,  black 
discoloration  of  the  mucous  membrane  of  the  mouth,  and  finally 
ulceration  of  the  throat,  diarrhea  and  albumin  in  the  urine.  Because 
of  the  protection  the  insoluble  compound  affords  to  the  part,  and 
also  because  it  is  just  sufficiently  astringent  to  act  as  a  stimulant  to  the 
sluggish  cells,  this  drug  may  be  called  an  ideal  antiseptic  when  applied 
to  abraded  surfaces. 

Therapeutics. — Until  recently  bismuth  subnitrate  had  not  been 
employed  in  dentistry.  In  medicine  it  has  long  been  a  standard 
remedy  in  both  acute  and  chronic  gastric  catarrh  and  gastric  ulcer. 
Beck  has  recently  proved  its  value  in  chronic  tubercular  sinuses. 
The  drug  is  now  extensively  employed  in  denlo-alveolar  sinuses, 
pyorrhea  pockets,  and  as  a  packing  for  wounds  after  surgical  operations 
about  the  roots  of  teeth  and  alveolar  process.  The  formula  for  Beck's 
paste  is:  Bismuth  subnitrate  30  parts,  white  wax  and  paraffin,  of  each, 
5  parts,  and  vaselin  60  parts.     Mix  with  heat. 

ARGENTUM— U.  S.  P. 

(Silver;    Ag.) 

Metallic  silver  is  used  extensively  in  dental  practice  in  the  form  of 
a  wire  for  suturing  fractured  jaws,  ligating  loose  teeth,  etc.  The 
most  important  salt  of  silver  used  in  dentistry  is  silver  nitrate,  which 
is  official. 


ARGENTI     M  I  KAS.  8l 

ARGENTI  NITRAS-U.  S.  P. 
(Silver  Nitrate;  Lunar  Caustic;   AgN03.) 

Silver  nitrate  occurs  in  colorless,  transparent,  tabular  crystals, 
odorless,  and  of.  a  caustic  and  rather  metallic  taste.  It  is  soluble 
in  about  0.6  part  of  water  and  in  26  parts  of  alcohol.  The  salt 
darkens  on  exposure  to  light,  and  should  be  kept  in  amber-colored 
bottles.  The  dose  is  from  1/6-1/2  gr.  (0.01-0.03  gm.).  The  official 
preparations  are: 

Argenti  Nitras  I'usus,  U.  S.  P.  (Silver  Nitrate  molded  into  hard, 
white  cones  or  pencils). 

Argenti  Nitras  Dilutus,  U.  S.  P.  (called  Mitigated  Caustic;  pen- 
cils or  moulded  cones,  containing  about  33  per  cent,  of  Silver 
Nitrate  and  the  balance  Potassium  Nitrate). 

Physiologic  Action. — While  silver  nitrate,  in  dilute  solution, 
acts  as  an  astringent  upon  mucous  membranes  and  raw  surfaces 
in  that  it  contracts  the  tissues  to  which  it  is  applied  by  precipitating 
the  albumin  of  the  cells,  in  concentrated  solutions  or  crystal  form 
it  acts  as  an  unirritating  caustic,  coating  and  protecting  the  parts  with 
white  silver  albuminate.  Much  investigation  has  been  done  by  den- 
tists in  regard  to  the  depth  of  penetration  of  silver  nitrate,  especially 
when  applied  to  the  tooth-structure.  The  prevailing  opinion  being 
that  its  penetration  is  limited  on  account  of  the  impenetrable  nature 
of  the  coagulum  formed. 

In  weak  solutions  (1:2500),  silver  nitrate  is  active  as  a  disinfec- 
tant. Internally  administered  in  medicinal  doses,  its  only  action  is 
that  of  an  astringent  and  antiseptic. 

The  long-continued  use  of  silver  nitrate,  even  when  locally  applied, 
may  result  in  a  condition  known  as  argyria.  The  manifestation  of 
this  condition  is  a  characteristic,  bluish-gray  discoloration  of  the 
skin  and  mucous  membranes.  As  a  rule,  it  does  not  interfere  with 
the  general  health  and  this  discoloration  is  permanent. 

Therapeutics.— Silver  nitrate  is  a  valuble  therapeutic  agent 
in  dentistry,  it  being  used  largely  for  its  caustic  action.  It  is  chiefly 
employed  for  its  beneficent  effect  on  unnaturally  exposed  tooth-structure, 
and  on  inflamed  mucous  membranes  and  ulcerative  surfaces.  To  exposed 
sensitive  ccmentum  it  may  be  applied  in  from  10  to  20  per  cent,  solu- 
tion, the  part  first  being  dried;  or  the  surface  to  be  cauterized  may  be 
left  moist  and  the  solid  stick  used.  Black  calls  attention  to  the  fact 
that  exposure  to  light  aids  the  action  of  the  salt. 

6 


82  OTHER    SILVER    SALTS    AND    SOLUBLE    COMPOUNDS. 

This  drug  is  one  of  the  best  caustics  for  destroying  exuberant  and 
superfluous  granulations,  for  which  purpose  a  solution  may  be  used  up 
to  50  per  cent,  in  strength.  In  chronic  stomatitis  a  2  to  5  per  cent, 
solution  may  be  used  with  advantage;  the  pencils  may  be  used  in 
lightly  touching  mucous  patches.  Elliot  recommends  a  10  per  cent, 
solution  as  a  local  application  in  the  cracks  which  frequently  occur 
about  the  hands  and  feet. 

Precautions. — There  is  little  danger  of  producing  argyria  from 
silver  nitrate  in  dental  practice,  yet  dentists  should  be  familiar  with 
this  condition.  In  using  the  drug,  care  should  be  taken  to  prevent 
the  cauterization  of  parts  not  intended,  as  the  patient's  lips,  gums, 
tongue,  buccal  mucous  membranes,  etc.  Sodium  chlorid  (common 
salt)  is  a  positive  antidote,  as  it  forms  with  the  drug  the  insoluble  and 
inert  silver  chlorid.  A  solution  of  the  antidote  should  always  be  in  a 
convenient  place  when  silver  nitrate  is  used  about  the  mouth. 

Incompatibles. — With  creosote  it  causes  an  explosion.  It  is 
also  incompatible  with  organic  matter,  and  many  salts,  as  chlorids, 
bromids,  iodids,  sulphids,  cyanids,  carbonates,  and  phosphates. 

OTHER  SILVER  SALTS  AND  SOLUBLE  COMPOUNDS. 

An  effort  has  been  made  by  manufacturing  chemists  to  produce 
compounds  of  silver  which  possess  the  stimulant  and  disinfectant 
power  of  silver  nitrate  and  which  will  not  precipitate  albumin  or 
chlorids.  Some  of  these  preparations  have  proved  exceedingly 
valuable. 

Argyrol  (Silver  Vitellin). — This  is  a  compound  of  a  derived 
vegetable  proteid  and  silver  oxid,  containing  from  20  to  25 • per  cent, 
of  silver.  It  occurs  in  black,  glistening,  hygroscopic  scales,  freely 
soluble  in  water  and  glycerin,  insoluble  in  alcohol  and  oils. 

Physiologic  Action  and  Therapeutics. — In  strong  solutions 
(20-50  per  cent.)  argyrol  is  claimed  to  be  nonirritating  to  mucous 
membranes.  It,  without  doubt,  possesses  marked  antiseptic  properties. 
It  is  recommended  in  nearly  all  diseased  conditions  of  the  mucous 
membranes;  as  in  stomatitis,  aphthous  sore  mouth,  maxillary  sinusitis, 
pharyngitis,  and  conjunctivitis.  Brophy  recommends  the  drug  in  the 
after-treatment  of  antral  operations.  It  is  used  in  from  10  to  50 
per  cent,  solutions.  It  will  stain  the  skin  and  mucous  membrane  as 
well  as  the  clothing.  Care  should  be  taken,  therefore,  in  using  the  drug 
not  to  stain  the  latter.  Hot  water  immediately  applied  will  remove 
the  stain  from  fabrics. 


BLEACHERS.  83 

Protargol.  -This  is  a  proteid  compound  containing  about  8  per 
cent,  of  silver.  It  occurs  as  a  fawn-colored  powder,  freely  soluble  in 
water.  It  is  claimed  to  be  a  good  disinfectant,  and  comparatively  free 
from  irritant  properties.  Its  action  is  similar  to  that  of  argyrol,  and  it 
is  used  for  practically  the  same  pathologic  conditions.  The  extreme 
solubility  of  argyrol  and  the  high  percentage  of  silver  which  it  con- 
tains has  caused  this  drug  to  largely  supersede  protargol  in  dental 
practice. 

BLEACHERS. 

Bleachers,  or  bleaching  agents,  have  been  denned  as  agents 
used  to  restore  the  color  of  tooth-structure.  The  methods  employed 
in  bleaching  teeth  will  be  described  in  detail  later  in  this  work. 
It  is  only  intended  here  to  discuss  the  drugs  used  for  this  purpose. 
However,  it  is  important  that  the  student  should  know  that  the  methods 
of  bleaching  teeth  involve  more  or  less  chemistry.  The  general 
principle  of  bleaching  teeth  is  to  chemically  change  the  insoluble 
colored  pigment  into  a  soluble  compound  so  that  it  may  be  washed 
out  of  the  tooth-structure,  or  else  chemically  attack  the  pigment  in 
such  a  way  as  to  break  up  its  molecular  arrangement  and  thus  destroy 
its  color.  This  may  be  accomplished  by  one  of  two  general  chemic 
processes — oxidation  or  reduction.  The  agents  used  for  bleaching 
teeth,  therefore,  can  be  divided  into  two  classes:  Those  which  oxidize 
and  those  which  reduce  the  pigment. 

OXIDIZING  AGENTS. 

This  class  of  drugs  may  also  be  conveniently  subdivided  into  two 
classes — direct  and  indirect  oxidizing  agents.  The  former  is  any  agent 
from  which  oxygen  may  be  obtained  directly,  and  the  latter  is  any  agent 
from  which  oxygen  may  be  obtained  indirectly. 

The  direct  oxidizing  agents  used  for  bleaching  teeth  are: 

Sodium  Dioxid.  Acetozone. 

Hydrogen  Dioxid.*  Alphozone. 

Oxalic  Acid. 

There  is  only  one  indirect  oxidizing  agent  used  and  that  is: 

Chlorin. 

SODII  DIOXIDUM— Unofficial. 

(Sodium  Peroxid;  Na202.) 

Sodium  dioxid  occurs  as  a  light  yellow,  more  or  less  granular 
powder.     It  is  chemically  soluble  in  water,  and  insoluble  in  absolute 


84  BLEACHERS. 

alcohol  and  chloroform.  It  readily  absorbs  moisture  from  the  air, 
thus  deteriorating,  and  is  best  kept  in  tightly  covered  tin  cans.  The 
drug  is  never  given  internally. 

Action. — To  speak  of  the  physiologic  action  of  sodium  dioxid 
would  be  incorrect,  for  it  is  such  a  violent  caustic  when  applied  to 
live  tissue  that  its  action  cannot  be  confined  within  physiologic  limits. 
It  is,  therefore,  rarely  used  in  medicine.  As  a  direct  oxidizing  agent 
for  bleaching  teeth,  where  its  action  can  be  confined  to  the  tooth- 
structure,  it  has  no  equal;  especially  is  this  true  when  the  sodium  dioxid 
is  decomposed  by  water,  which  liberating  nascent  oxygen  forms  sodium 
hydroxid  as  a  by-product.  The  nascent  oxygen  attacks  the  pigment 
which  has  stained  the  tooth,  and  the  sodium  hydroxid  attacks  any 
fatty  substances  which  may  be  present,  forming  therewith  a  soluble 
soap.  This  double  action  of  sodium  dioxid,  when  decomposed  by 
water,  gives  to  the  agent  its  great  advantage  as  a  bleaching  agent. 
The  drug  may  be  decomposed  by  acids  with  the  liberation  of  nascent 
oxygen,  but  by  this  means  the  valuable  by-product  (sodium  hydroxid) 
is  destroyed.  Used  in  this  way,  then,  sodium  dioxid  has  no  ad- 
vantage over  any  other  agent  which  liberates  an  equal  volume  of 
oxygen.  It  is  a  fact  long  recognized  by  those  engaged  in  the  bleaching 
of  hair,  feathers,  wool,  broom-corn,  ivory,  bone,  etc.,  that  the  bleach- 
ing process  is  favored  when  carried  on  in  an  alkaline  medium.  This 
is  likewise  true  in  bleaching  teeth. 

Therapeutics. — In  dental  practice,  where  the  violent  caustic 
properties  of  sodium  dioxid  can  be  confined  to  the  tooth-structure, 
this  agent  has  a  rather  wide  range  of  usefulness.  Both  the  powder 
and  a  solution  made  by  carefully  adding  the  powder  to  cold  water  are 
used. 

There  are  two  important  reactions  which  take  place  when  sodium 
dioxid  is  added  to  water,  and  it  is  well  to  explain  these  here.  If  the 
powder  is  added  to  water  in  small  quantities,  care  being  taken  to  keep 
down  the  temperature  with  ice  or  cold  water,  a  reaction  takes  place 
which  results  in  a  solution  containing  hydrogen  dioxid  and  sodium 
hydroxid.  This  solution  freshly  prepared  may  be  used  for  bleaching 
teeth.  The  hydrogen  dioxid  will  liberate  oxygen  which  does  the 
bleaching  and  the  sodium  hydroxid  creates  an  alkaline  medium  which 
favors  the  bleaching  process;  it  also  acts  to  advantage  upon  any  fats 
which  may  be  present.  The  great  difficulty  here  is  in  obtaining  the 
solution  fresh,  as  the  sodium  hydroxid  gradually  decomposes  the  hy- 
drogen dioxid  into  water  and  oxygen,  the  latter  gas  being  lost.  If 
sodium  dioxid  is  added  to  water  without  any  precaution  to  lowering 


ACETOZONE.  85 

the  temperature,  a  somewhat  different  reaction  takes  place.  Here  the 
drug  is  at  once  decomposed  into  oxygen  and  sodium  hydroxid.  For 
all  dental  purposes  this  is  the  best  way  to  use  the  drug,  viz. :  Place 
the  powder  into  the  cavity  or  canal  •of  the  tooth  and  decompose  it 
into  oxygen  and  sodium  hydroxid  by  adding  distilled  water.  In  this 
way  it  may  be  used  for  bleaching  teeth,  disorganizing  remnants  of  pulp 
tissue,  and  enlarging  tortuous  root  canals.  For  the  latter  purposes  the 
use  of  the  drug  should  alternate  with  a  50  per  cent,  solution  of  sul- 
phuric acid. 

Incompatibles. — Sodium  dioxid  will  produce  a  pyrotechnic 
display  with  many  of  the  volatile  oils  and  with  phenol.  It  is  decom- 
posed by  water  and  acids. 

Hydrogen  Dioxid. 

This  direct  oxidizing  agent  has  been  fully  discussed  under  the 
heading  of  Disinfectants.  The  official  3  per  cent,  solution  is  sometimes 
concentrated  or  used  with  other  drugs  for  bleaching  purposes.  As  a 
bleacher  this  solution  has  largely  been  superseded  by  the  commercial 
preparation  called  "caustic  pyrozone,"  which  is  a  25  per  cent,  ethereal 
solution  of  pure  hydrogen  dioxid.  Like  all  direct  oxidizers,  its  value 
depends  upon  the  nascent  oxygen  which  it  liberates.  For  bleaching 
teeth  better  results  are  produced  when  the  tooth-structure  has  been 
previously  moistened  with  a  weak  alkaline  solution,  such  as  lime-water. 

ACETOZONE— Unofficial. 

(Benzoylacetyl  Dioxid;  C6HsCOO.O.COCH3.  =C9  H804.) 
Acetozone,  or  benzoylacetyl  dioxid,  is  made  by  the  oxidation 
of  a  mixture  of  benzaldehyd  and  acetic  anhydrid.  It  occurs  as  a 
white,  shining  crystalline  powder.  Slightly  soluble  in  water,  alcohol, 
and  fairly  so  in  ether  and  chloroform.  In  oils  it  is  soluble  to  the  extent 
of  about  3  per  cent.  All  solvents  slowly  decompose  the  drug  with  the 
exception  of  neutral  petroleum  oils.  Not  used  internally  in  dentistry. 
Action  and  Uses. — Acetozone  belongs  to  a  class  of  compounds 
known  as  the  organic  dioxids  or  peroxids  in  which  an  excess  of  oxygen 
has  been  combined  in  such  a  way  that  it  is  slowly  given  off  in  the 
nascent  state.  In  the  presence  of  water  it  hydrolyzes,  forming  benzo- 
peracid  and  aceto-peracid  which  exert  marked  oxidizing  and  disin- 
fectant action.  Acetozone  is  used  in  dentistry  as  a  bleaching  agent. 
Hoff  recommends  placing  the  powder  in  the  cavity  of  the  tooth  to  be 
bleached,  moisten  with  water  to  bring  about  the  hydrolysis,  and  her- 
metically seal. 


86  BLEACHERS. 

ALPHOZONE— Unofficial. 

(Succinic  Dioxid;   (COOH.CH2.CH2.CO)202  =C8HI008.) 

Alphozone,  or  succinic  dioxid,  is  an  organic  dioxid,  or  peroxid, 
resulting  from  the  condensation  of  hydrogen  dioxid  with  succinic 
anhydrid.  It  occurs  as  a  fluffy,  white,  crystalline  powder.  Soluble 
in  30  parts  of  water  at  ordinary  temperature;  moderately  soluble  in 
alcohol,  sparingly  so  in  ether,  and  insoluble  in  chloroform.  It  should 
be  kept  in  a  dark  place  and  in  tightly  stoppered  bottles.  Not  used  in- 
ternally in  dentistry. 

Action  and  Uses. — Alphozone  is  a  powerful  oxidizer,  and  thus 
becomes  an  antiseptic,  disinfectant,  and  deodorant.  It  possesses 
marked  bleaching  properties.  It  is  claimed  to  possess  an  advantage 
over  hydrogen  dioxid  as  a  therapeutic  agent  in  that  it  does  not  effervesce 
with  pus  nor  in  contact  with  living  tissues.  Alphozone  may  be  used 
for  bleaching  teeth  in  the  same  manner  as  acetozone.  Water  does  not 
decompose  the  drug.  It  may  also  be  employed  for  disinfecting  the 
hands  and  such  instruments  as  are  not  attacked  by  oxidizing  agents. 
The  drug  can  be  obtained  in  the  powder  form  or  in  tablets  containing 
one  grain  (0.065  gm-)  each,  which  is  used  for  making  solutions  for 
external  use.  One  tablet  to  2  fl.  oz.  (60.0  c.c.)  makes  a  suitable  dis- 
infectant solution  for  general  use. 

ACIDUM  OXALICUM— Unofficial. 

(Oxalic  Acid;  H2C204+H20.) 

Oxalic  acid  occurs  in  the  form  of  transparent,  prismatic  crystals, 
odorless,  and  of  a  very  acid  taste.  It  is  readily  soluble  in  water  and 
alcohol.     Not  used  internally  in  dentistry. 

Action  and  Uses. — Oxalic  acid  is  a  direct  oxidizer.  As  a  bleach- 
ing agent  for  teeth  its  power  is  limited.  Kelley  and  others  have 
recommended  it  as  a  disinfectant  for  the  hands. 

CHLORUM— Unofficial. 

(Chlorin;  CI.) 

Chlorin  is  a  heavy,  yellowish-green  gas,  of  a  very  suffocating  odor 
and  a  caustic  taste.  It  may  be  prepared  by  acting  upon  chlorinated 
lime  with  an  acid.  The  gas  is  soluble  in  water.  One  official  prepara- 
tion: 

Liquor  Chlori  Compositus,    U.    S.  P.  (contains  about  0.4  per 
cent,  of  the  gas.) 


REDUCING    AGENTS.  87 

Action  and  Uses. — Chlorin  is  a  powerful  irritant.  When  inhaled 
it  causes  inflammation,  and,  at  times,  edema  of  the  lungs.  It  has  such 
a  great  affinity  for  hydrogen  that  it  will  abstract  this  element  from  a 
molecule  of  water,  liberating  the  oxygen  in  the  nascent  state.  Because 
of  this  fact  it  is  an  indirect  oxidizing  agent,  and  its  bleaching  ability  as 
well  as  its  disinfectant  power  depends  upon  this  property.  About  the 
the  only  use  made  of  chlorin  in  dental  practice  is  as  a  bleaching  agent. 
It  bleaches  indirectly.  For  bleaching  teeth,  compounds  and  preparations 
of  chlorin,  from  which  the  gas  is  liberated,  are  used. 


CALX  CHLORINATA— U.  S.  P. 

(Chlorinated  Lime;  CaOCl  +CaCl2.) 

Chlorinated  lime  is  a  mixture  of  calcium  hypochlorite  and  calcium 
chlorid.  It  is  prepared  by  acting  upon  slacked  lime  with  chlorin  gas, 
and  should  contain  not  less  than  30  per  cent,  of  chlorin.  It  occurs  as 
a  grayish-white  powder,  having  a  strong  odor  of  chlorin  and  a  disa- 
greeable saline  taste.     It  is  partially  soluble  in  water  and  alcohol. 

Action  and  Uses. — As  the  mixture  constantly  liberates  chlorin 
gas,  it  is  a  disinfectant  and  bleacher.  It  is  used  in  dentistry  as  a  means 
of  obtaining  chlorin  for  bleaching  teeth. 


LIQUOR  SOD.E  CHLORINATE— U.  S.  P. 

(Solution  of  Chlorinated  Soda;  Labarraque's  Solution.) 

This  is  a  solution  of  several  chlorin  compounds  of  sodium  con- 
taining at  least  2.4  per  cent,  by  weight  of  available  chlorin. 

Action  and  Uses. — Solution  of  chlorinated  soda  is  a  disinfectant, 
deodorant  and  bleacher.  Like  chlorinated  lime,  it  is  used  in  dentistry 
as  a  means  of  obtaining  chlorin  for  bleaching  teeth.  The  solution 
should  be  freshly  prepared. 


REDUCING  AGENTS. 

These  are  agents  which  have  the  power  of  abstracting  oxygen 
from  a  compound  containing  it.  The  process  is  called  reduction  or 
deoxidation. 

There  is  only  one  reducing  agent  used  for  bleaching  teeth.  Thai 
is  sulphurous  acid. 


88  ESCHAROTICS    OR    CAUSTICS. 

ACIDUM  SULPHUROSUM— U.  S.  P. 

(Sulphurous  Acid;  H2S03.) 

The  official  solution  of  sulphurous  acid  is  a  6  per  cent,  aqueous 
solution  of  sulphur  dioxid. 

Action  and  Uses. — Sulphur  dioxid  is  a  gas  which  chemically 
dissolves  in  water  and  forms  sulphurous  acid.  This  acid  has  a  great 
affinity  for  oxygen,  and  absorbs  the  latter  gas  from  the  air  or  abstracts 
it  from  compounds  containing  it,  thus  reducing  the  compound  and 
forming  sulphuric  acid. 

For  bleaching  teeth  it  is  best  to  use  a  mixture  of  such  compounds 
as  when  dissolved  will  react  upon  each  other  and  produce  sulphur 
dioxid  within. the  tooth  to  be  bleached.  The  gas  unites  with  the 
water  present  forming  sulphurous  acid  which  has  a  tendency  to  ab- 
stract oxygen  from  the  colored  pigment  which  has  stained  the  tooth, 
and  thus  the  rearrangement  of  the  elements  of  the  colored  molecule 
destroys  its  color.  Kirk  suggests  using  a  mixture  of  10  parts  of  so- 
dium sulphite  and  7  parts  of  boric  acid.  This  mixture  may  be  packed 
into  the  cavity  of  the  tooth,  moistened  with  water,  and  hermetically 
sealed.  The  tooth  should  subsequently  be  washed  with  an  alkaline 
solution  to  neutralize  the  acid  formed. 

ESCHAROTICS  OR  CAUSTICS. 

Escharotics  or  caustics  are  agents  which  destroy  the  tissue 
upon  which  they  act.  While  the  action  of  this  class  of  drugs  varies 
with  the  drug  employed,  it  may  be  stated  in  general  that  their  action  is 
purely  chemic  or  physico-chemic.  Many  of  them  have  an  imme- 
diate chemic  action  upon  the  tissues,  and  are  sometimes  called 
corrosives.  Nearly  all  escharotics  produce  an  eschar,  the  character 
of  which  depends  largely  upon  the  tissue  involved.  This  eschar  is 
ultimately  separated  from  the  living  tissues  by  the  inflammatory 
process  thus  inaugurated.  Some  of  the  agents  belonging  to  this  class 
are  quite  readily  absorbed,  and  may  cause  systemic  poisoning.  The 
compounds  of  arsenic — especially  arsenic  trioxid,  long  used  in  dentistry 
for  devitalizing  the  pulps  of  teeth — are  of  this  character,  as  they  have 
a  specific  poisonous  action  upon  the  cells.  The  salts  of  chromium 
and  osmium  may  also  be  mentioned  in  this  connection.  The  strong 
mineral  acids  abstract  water  from  the  tissues  and  precipitate  the  pro- 
teids;  the  alkaline  hydrates,  on  the  other  hand,  not  only  abstract  water 
but  dissolve  the  proteids  and  form  with  them  soluble  compounds. 


ACIDUM    SULPHURICUM.  89 

The  chief  escharotics  art': 

Mineral  Acids:  Arsenic  Trioxid. 

Sulphuric  Acid.  Chromium  Trioxid. 

Nitric  Acid.  Osmic  Acid. 

Hydrochloric  Acid.  Potassium  Hydroxid. 

I'licnol.*  Sodium  Hydroxid. 

Acetic  Acid.  Zinc  Chlorid. 

Trichloracetic  Acid.  Mercuric  Chlorid.* 

Monochloracetic  Acid.  Silver  Nitrate.* 

Lactic  Acid.  Actual  Cautery. 

Several   of   the  above  escharotics   have  been  considered   elsewhere. 
Those  which  have  not  will  here  be  discussed  in  detail. 

ACIDUM  SULPHURICUM  -U.  S.  P. 
(Sulphuric   Acid;  Oil  of  Vitriol;  H2S04.) 

Sulphuric  acid  is  a  colorless,  heavy,  oily  liquid,  without  odor, 
and  of  an  extremely  sour  taste  and  acid  reaction.  It  is  miscible  with 
water  and  alcohol  in  all  proportions  with  the  evolution  of  heat.  A 
precaution  to  be  remembered  is  that  in  diluting  the  acid  should  be 
added  to  the  water  or  other  diluent,  and  not  the  reverse.  The  acid  is 
not  used  internally  in  dentistry.     The  official  preparations  are: 

Acidum  Sulphuricum  Dilutum,  U.  S.  P.  (Contains  10  per  cent, 
of  absolute  sulphuric  acid.) 

Acidum  Sulphuricum  Aromaticum,  U.  S.  P.  (Contains  'about 
10  per  cent,  of  sulphuric  acid  in  alcohol  with  the  addition  of 
such  aromatics  as  ginger  and  cinnamon.) 

Phenolsulphonic  acid  is  prepared  from  phenol  and  chemically 
pure  sulphuric  acid.  It  occurs  as  a  reddish-colored,  heavy,  oily  liquid, 
of  a  rather  phenol-like  odor  and  a  characteristic  acid  taste  and  reaction. 
It  unites  with  some  bases  to  form  salts,  notably  zinc.  It  is  rather 
difficult  to  combine  phenol  and  sulphuric  acid  so  that  the  resultant 
mixture  may  be  diluted  with  water  without  separation  of  the  original 
constituents.  Inasmuch  as  the  concentrated  phenolsulphonic  acid 
is  rarely  used  in  dentistry,  directions  here  follow  for  preparing  a  50 
per  cent,  solution:  Heat  95  per  cent,  phenol  in  a  test-tube,  evaporat- 
ing dish,  or  beaker  nearly  to  boiling,  then  gradually  add  an  equal 
amount  of  sulphuric  acid;  then,  while  still  hot,  add  as  much  warm 
distilled  water  as  was  taken  of  both  phenol  and  sulphuric  acid.  This 
solution  is  miscible  with  water  in  all  proportions. 

Physiologic  Action.— When  applied  to  the  skin,  accidentally  or 
otherwise,  sulphuric  acid  in  concentrated  form  causes  an  intense, 
burning  pain,  and  results  in  a  rapid  destruction  of'tissue.     The  eschar 


<po  ESCHAROTICS    OR  CAUSTICS. 

is  at  first  white,  gradually  becoming  brown.  The  corrosive  effect  upon 
mucous  membranes  is  still  more  marked  than  upon  the  skin.  The 
acid  rapidly  extracts  water  from  the  tissue,  the  alkalies  are  neutralized, 
and  the  proteids  precipitated,  this  results  in  the  complete  destruction 
of  the  tissue  (dissolution).  When  taken  internally  large  doses  cause 
burning  in  the  throat  and  esophagus,  violent  pain  in  the  abdomen, 
constant  vomiting  of  dark  matter,  mixed  with  blood  and  mucus, 
difficult  breathing,  and  ultimate  collapse. 

Therapeutics. — Sulphuric  acid  is  used  in  dentistry  more  than  any 
of  the  other  mineral  acids.  Because  of  its  violent  action  upon  soft 
tissue,  it  is  seldom  used  as  an  escharotic  except  at  times  on  pulp  tissue 
where  its  action  can  be  controlled.  By  some  it  is  used  in  50  per  cent, 
solution  to  neutralize  the  contents  of  putrescent  root-canals,  and  for 
enlarging  fine  and  tortuous  canals.  This  is  known  as  the  Callahan 
method.  It  may  also  be  employed  to  destroy  a  remnant  of  a 
pulp  in  the  apical  end  of  a  root,  and  for  dislodging  pulp  nod- 
ules in  the  pulp-chambers  and  root-canals  of  teeth.  A  10  per  cent, 
solution  may  be  cautiously  used  for  sterilizing  the  dentin  and  opening 
the  tubules  previous  to  removing  a  pulp  by  pressure  anesthesia  or 
bleaching  the  tooth-structure.  Care  must  always  be  exercised  in  the 
use  of  sulphuric  acid,  even  in  weak  solutions,  not  to  get  the  agent  on 
the  enamel  of  the  crown  of  the  tooth  or  soft  tissues  of  the  mouth.  It 
should  be  remembered  here  that  a  weak  solution  of  an  alkaline  salt, 
such  as  sodium  bicarbonate,  will  at  once  neutralize  the  action  of  all 
mineral  acids,  and  such  a  solution  should  be  ready  to  use  when  these 
agents  are  employed.  Perhaps  the  most  useful  combination  of  sul- 
phuric acid  in  dental  practice  is  phenolsulphonic  acid.  This  agent  may 
be  used  in  nearly  every  instance  where  sulphuric  acid  is  indicated 
and  often  to  advantage.  In  caries  or  necrosis  of  bone,  in  chronic  alveolar 
abscess,  and  pyorrhea  alveolaris,  where  the  "acid  treatment"  is  indi- 
cated, phenolsulphonic  acid,  properly  employed,  will  give  beneficial 
results. 

Incompatibles. — Sulphuric  acid  is  incompatible  with  alkalies, 
alkaline  carbonates,  iodids,  and  certain  salts  of  lead.  It  is  explosive 
with  oil  of  turpentine  and  sugar,  and  carbonizes  syrups  because  of  the 
sugar  therein  contained. 

ACIDUM  NITRICUM— U.  S.  P. 

(Nitric  Acid;  Aqua  Fortis;  HN03.) 

Nitric  acid  is  a  strongly  corrosive,  fuming,  caustic  liquid,  com- 
posed of  68  per  cent,  absolute  nitric  acid  and  32  per  cent,  of  water  with 


ACIDUM    HYDKOCHLORICUM.  91 

which  liquid  it  is  miscible  in  all  proportions.  It  reacts  explosively 
with  alcohol  and  glycerin,  and  is  not  used  internally  in  dentistry. 
The  official  preparations  are: 

Acidum  Nitricum  Dilutum,  U.  S.  P.  (10  per  cent.). 

Acidum  Nitrohydrochloricum,  U.  S.  P.  (Aqua  Regia;  Nitric  Acid 

18  vols.;  Hydrochloric  Acid  82  vols.). 

Acidum  Nitrohydrochloricum  Dilutum,  U.  S.  P.  (approximately 

10  per  cent,  absolute  Acid). 

Physiologic  Action  and  Therapeutics. — Nitric  acid,  though  a 
powerful  escharotic,  is  not  as  penetrating  or  painful  as  sulphuric  acid. 
It  produces  a  characteristic  yellow  stain  on  the  skin  and  mucous 
membrane.  In  large  doses  it  causes  practically  the  same  train  of 
symptoms  as  sulphuric  acid,  except  the  yellow  instead  of  the  white  and 
then  brown  discoloration.  The  acid  is  not  used  to  any  extent  in 
dental  practice.  It  may  be  applied  to  warts  and  other  fungous  growths, 
and  has  proved  to  be  a  reliable  agent  in  phagedenic  ulcers,  chancroids 
and  chancres. 

Incompatibles. — This  acid  is  incompatible  with  alkalies,  alkaline 
carbonates,  oxids,  lead  acetate,  and  iron  sulphate.  It  explodes  with 
such  agents  as  alcohol,  glycerin,  phenol,  and  volatile  oils. 

ACIDUM  HYDROCHLORICUM— U.  S.  P. 

(Hydrochloric  Acid;  Muriatic  Acid;  HC1.) 

Hydrochloric  acid  is  a  fuming,  corrosive  liquid,  consisting  of 
31.9  per  cent,  of  absolute  hydrochloric  acid.  It  is  miscible  with  water 
and  alcohol  in  all  proportions.  It  is  not  used  internally  in  dentistry. 
The  official  preparation  is: 

Acidum  Hydrochloricum  Dilutum,  U  .S.  P.   (10  per  cent,  by 
weight.) 

Physiologic  Action  and  Therapeutics. — The  action  of  hydro- 
chloric acid  closely  resembles  that  of  the  other  mineral  acids.  As  a  thera- 
peutic agent  the  strong  acid  is  not  used  to  any  extent  in  dentistry. 
It  is  chiefly  used  to  prepare  the  diluted  and  other  acids.  Dilute 
hydrochloric  acid  has  been  used  by  Andrew  and  Morris  for  the  re- 
moval of  sequestra,  and  necrosed  bone  in  osteitis  and  caries.  It  is 
inferior  to  phenolsulphonic  acid  for  these  purposes. 

Incompatibles. — The  acid  is  incompatible  with  alkalies,  carbon- 
ates, and  silver  nitrate. 


92  ESCHAROTICS    OR    CAUSTICS 

Treatment  of  Poisoning  by  Mineral  Acids. — The  treatment 
of  poisoning  by  the  mineral  acids  to  be  effective  should  be  prompt. 
The  cautious  administration  of  alkalies  is  indicated  to  chemically 
neutralize  the  acid.  Lime-water,  magnesia,  and  soap  are  best. 
Carbonates  must  be  used  with  care,  if  at  all,  on  account  of  the  lia- 
bility to  rupture  the  stomach  from  the  evolution  of  carbon  dioxid  (a 
gas).  Stevens  cautions  against  the  use  of  the  stomach-pump  on  account 
of  the  risk  of  piercing  the  softened  esophagus.  After  the  acid  is 
neutralized  with  the  alkaline  solutions,  demulcent  drinks,  such  as 
albumin-water,  milk  and  raw  eggs,  should  be  given  to  soothe  the  parts. 
To  control  the  pain,  opium,  or  its  alkaloids,  are  indicated,  and  whisky 
or  brandy  should  be  injected  subcutaneously  in  case  of  collapse. 


ACIDUM  ACETICUM— U.  S.  P. 
(Acetic  Acid;  HC2H302.) 

Acetic  acid  is  a  liquid  composed  of  36  per  cent,  by  weight  of  abso- 
lute acetic  acid  and  64  per  cent,  of  water.  It  occurs  as  a  clear,  color- 
less liquid,  having  a  strong,  vinegar-like  odor,  and  a  purely  acid  taste. 
Miscible  with  water  and  alcohol  in  all  proportions.  The  dose  of  the 
diluted  acid  is  1-2  fl.  dr.  (4-8  c.c).     The  official  preparations  are: 

Acidum  Aceticum  Dilutum,  U.  S.  P.  (6  per  cent,  by  weight  of 
absolute  Acetic  Acid). 

Acidum  Aceticum  Glaciale,  U.  S.  P.  (Glacial  Acetic  Acid;  99 
per  cent,  absolute  Acid). 

Physiologic  Action. — The  concentrated  acetic  acid  when 
applied  locally  produces  redness,  vesication,  and  ultimately  slight 
sloughing.     Internally  it  causes  severe  gastritis. 

Therapeutics. — Acetic  acid  is  applied  externally  to  indolent 
ulcers  of  the  mouth  and  canker  sores.  A  weak  solution  may  be  used 
as  a  gargle  in  cases  of  pharyngitis  or  sore  throat.  Glacial  acetic  acid 
may  be  applied  to  fungous  growths  in  the  mouth.  It  is  also  used  to 
remove  warts  and  corns.  The  dilute  acid  or  vinegar  is  especially 
indicated  as  an  antidote  in  cases  of  poisoning  by  alkalies.  The  quantity 
to  be  given  must  be  governed  larg'ely  by  the  probable  amount  of 
alkali  to  be  neutralized.  In  bleaching  teeth  with  sodium  dioxid,  or  in 
using  the  caustic  alkalies  about  the  teeth,  a  weak  solution  of  acetic 
acid  should  be  at  hand  to  neutralize  any  alkali  which  may  get  on  the 
soft  tissues  of  the  mouth. 


ACIDUM    TRICIILORACETICUM— ACIDUM    LACTICUM.  93 

ACIDUM  TRICHLORACETICUM-  U.  S.  P. 

(Trichloracetic  Acid;  HC2C1302.) 

Trichloracetic  acid  occurs  as  white,  deliquescent  crystals,  freely 
soluble  in  water,  alcohol,  and  ether.  It  is  made  by  acting  on 
glacial  acetic  acid  with  chlorin  or  on  hydrated  chloral  with  fuming 
nitric  acid. 

Physiologic  Action  and  Therapeutics. — Trichloracetic  acid 
acts  as  an  escharotic,  astringent,  and  hemostatic.  A  solution  of  5  to 
10  per  cent,  may  be  applied  to  indolent  ulcers,  mucous  patches,  etc.  A 
10  to  20  per  cent,  solution  is  an  excellent  stimulating  agent  to  be 
forced  through  a  sinus  in  chronic  alveolar  abscess  and  into  a  stubborn 
pyorrheal  pocket.  It  may  also  be  employed  in  this  strength  solution 
as  a  hemostatic  in  case  of  profuse  hemorrhage  after  the  removal  of  the 
pulp  by  pressure  anesthesia.  The  pure  drug  or  in  concentrated 
solution  has  been  employed  to  some  extent  for  the  removal  of  small 
growths  about  the  mouth,  such  as  hypertrophied  gum  or  pulp  tissue. 
The  agent  is  also  used  for  the  removal  of  warts  and  corns. 

Monochloracetic  Acid.  (HC2H2C102). — This  agent  occurs 
as  a  white  crystalline  substance,  soluble  in  water  and  alcohol.  As 
shown  by  the  formula,  only  one  of  the  hydrogen  atoms  in  glacial 
acetic  acid  is  displaced  by  chlorin.  Harlan  recommended  the  use  of 
this  agent  in  the  treatment  of  putrescent  canals  of  teeth.  The  remedy 
never  gained  any  favor,  as  its  action  is  uncertain. 

ACIDUM  LACTICUM— U.   S.  P. 

(Lactic  Acid;   HC3Hs03.) 

Lactic  acid  is  an  organic  acid  usually  obtained  by  the  fermenta- 
tion of  grape-sugar  or  milk-sugar.  The  official  preparation  is  com- 
posed of  75  per  cent,  absolute  lactic  acid  and  25  per  cent,  of  water  and 
occurs  as  a  syrupy  liquid.  Besides  being  miscible  with  water,  it  will 
mix  with  alcohol  and  ether  in  all  proportions.  The  dose  is  about 
30  min.  (2.0  c.c). 

Physiologic  Action  and  Therapeutics. — Lactic  acid  acts  as  a 
mild  caustic  on  mucous  surfaces.  It  is  also  a  stimulant  and  refrigerant. 
Younger  advocates  the  use  of  the  official  acid  (75  per  cent.)  as  a  stimu- 
lating agent  in  pyorrhea  alveolar  is.  After  the  roots  are  scaled,  the  acid 
is  warmed  and  injected  into  the  pockets.  Stevens  recommends  a 
20  to  50  per  cent,  solution  to  be  applied  to  tuberculous  and  lupous 
ulcerations  of  mucous  membranes. 


94  ESCHAROTICS    OR    CAUSTICS. 

ARSENI  TRIOXIDUM— U.  S.  P. 

(Arsenic  Trioxid;  Arsenous  Acid;   White  Arsenic;   As203.) 

Arsenic  trioxid  occurs  as  a  white  powder  or  in  heavy  masses. 
It  has  neither  odor  nor  taste.  Sparingly  soluble  in  water  and  alcohol; 
soluble  in  5  parts  of  glycerin,  and  readily  soluble  in  acids  and  alkalies. 
In  the  presence  of  water  it  reacts  and  forms  arsenous  acid  (H3As03). 
The  dose  is  from  1/60-1/ 20  gr.  (0.001-0.003  &m0' 

Physiologic  Action. — Internally  administered  in  the  proper 
form  and  dose  arsenic  acts  as  an  alterative.  It  is  the  local  action 
with  which  dentists  are  mostly  interested.  Applied  to  denuded  sur- 
faces, such  as  an  exposed  pulp,  unless  its  action  is  controlled,  arsenic 
trioxid  is  a  powerful  and  painful  escharotic.  It  is  readily  absorbed 
by  the  tissue,  and  exerts  a  specific  poisonous  action  upon  the  cells. 
It  is  a  peculiar  escharotic,  and  stands  in  a  class  by  itself.  Long1  states 
that  "the  dry  powder  may  be  placed  on  the  tongue  and  allowed 
to  remain  for  one  minute  without  causing  the  slightest  irritation  and, 
if  then  thoroughly  removed,  without  producing  any  effect  upon  the 
tissues.  On  the  contrary,  if  it  is  allowed  to  remain  until  it  becomes 
dissolved  and  penetrates  the  tissues,  extensive  sloughing  will  result. 
It  acts  only  after  being  absorbed  by  the  tissue  elements,  altering  or 
destroying  their  vital  processes  in  an  obscure  manner.  Because  of 
this  action  it  is  difficult,  if  not  impossible,  to  limit  or  antagonize  its 
influence  upon  the  tissue  which  it  has  penetrated;  and  its  penetration 
is  not  limited  by  any  action  of  its  own,  as  it  does  not  coagulate  albumin. 
The  fact  of  its  being  tasteless  and  nonirritating  at  first  renders  its  use 
about  the  mouth  the  more  dangerous,  for  by  careless  handling  it  may 
become  lodged  about  the  teeth  or  beneath  the  edge  of  the  gum,  and  its 
presence  be  not  appreciated  for  hours,  until  divitalization  of  the  tissue 
has  begun." 

Under  certain  conditions,  which  are  not  well  understood,  the 
pulp  tissue,  though  exposed,  will  absolutely  resist  the  action  of  arsenic 
trioxid.  When  this  occurs  the  tissue  will  generally  be  found  to  be 
equally  resistant  to  other  drugs.  It  is  claimed  that  many  of  the 
peasants  of  Austria  have  acquired  a  toleration  for  the  drug,  and  can 
take  large  doses  without  any  untoward  effects. 

Poisoning  and  Treatment. — Arsenical  poisoning  may  well  be 
considered  in  two  forms — local  and  systemic.  Local  arsenical  poisoning 
occurs  most  frequently  by  the  escape  of  arsenical  preparations  from 
the  cavity  in  the  devitalization  of  pulp  tissue.     There  is  seldom  any 

1  Dental  Materia  Medica,  Therapeutics  and  Prescription  Writing. 


ARSENIC    TRIOXID.  95 

pain  connected  with  the  devitalization  of  the  gum  tissue,  and  herein 
lies  the  great  danger  of  extensive  necrosis  of  the  soft  and  frequently 
the  bony  structures.  The  prominent  symptom  is  a  white  gum, 
absolutely  lifeless;  there  may  be  pain,  most  frequently  this  symptom 
is  absent;  the  tooth  becomes  sore  to  percussion.  In  the  more  severe 
cases  the  destruction  of  soft  tissue,  if  unnoticed,  goes  on  until  the 
alveolar  process  between  the  affected  teeth  becomes  involved  and  is 
destroyed.  Sometimes  the  affected  tooth  is  lost,  together  with  one 
or  two  teeth  on  either  side. 

In  the  treatment  of  local  arsenical  poisoning  where  the  drug  has 
remained  only  long  enough  to  cause  devitalization  of  the  gum  tissue, 
all  that  is  necessary  is  to  first  wash  the  part  with  an  antiseptic  solution 
and  then  mechanically  pick  off  the  dead  or  sloughed  tissue  with  sterile 
pliers  until  hemorrhage  ensues,  if  this  is  possible;  after  which  stimu- 
lating disinfectants  should  be  employed.  Here  is  a  good  place  to  use 
the  official  solution  of  hydrogen  dioxid.  The  cavity  is  open  and  there 
is  no  danger  of  spreading  a  possible  infection.  After  removing  the 
dead  tissue  and  disinfecting,  the  author  suggests  drying  the  part  and 
covering  it  with  the  oleoaginous  euroform  paste.  The  patient  should 
be  instructed  to  keep  the  mouth  clean  by  the  use  of  an  antiseptic 
wash,  and  the  local  treatment  repeated  every  day  until  granulations 
begin  to  form;  usually  one  or  two  treatments  will  suffice. 

In  those  severe  cases  where  the  agent  has  penetrated  to  and  devital- 
ized the  alveolar  process,  as  well  as  the  overlying  soft  tissue,  the  first 
treatment  is  surgical.  After  washing  with  an  antiseptic  solution,  the 
affected  part  should  be  thoroughly  curetted  with  a  bone  curet  or  a 
suitable  bur  in  the  engine.  It  may  be  necessary  in  extensive  cases  to 
extract  the  affected  tooth,  after  which  the  treatment  is  practically  the 
same  as  has  been  outlined  above,  except  where  there  has  been  much 
removal  of  tissue  in  operating  it  is  best  to  pack  the  part  at  first  with 
plain  gauze  thoroughly  saturated  with  the  euroform  paste.  The  case 
should  be  watched  closely,  and  the  stimulating  treatment  kept  up  until 
the  part  has  healed.  The  tissue  in  the  interproximal  space  will  never 
be  fully  reproduced,  and  will  always  be  the  source  of  more  or  less 
annoyance. 

Acute  systemic  arsenical  poisoning  is  manifested  by  severe  ab- 
dominal pains,  vomiting  and  purging  of  "rice-water,"  persistent  thirst, 
muscular  cramps,  cyanosis,  and  collapse.  Death  usually  occurs  in 
from  one  to  three  days,  and  is  often  preceded  by  delirium,  convulsions, 
and  coma.  If  recovery  follows,  the  acute  symptoms  may  be  gradually 
replaced  by  those  of  chronic  arsenical  poisoning.     This  condition  may 


96  ESCHAROTTCS    OR    CAUSTICS. 

also  follow  the  prolonged  use  of  the  drug  as  a  medicine,  may  result  from 
the  use  of  foods  or  liquors  contaminated  with  arsenic  (beer,  etc.),  may 
occur  from  constant  inhalation  of  dust  arising  from  wall-paper  or  other 
fabrics  colored  with  arsenical  pigments,  or  may  be  acquired  by  work- 
men in  arsenic  mines,  or  in  factories  in  which  fumes  of  the  metal  are 
formed.  This  form  of  poisoning  may  be  manifested  by  gastroenteritis, 
conjunctivitis,  and  catarrh  of  the  upper  air-passages,  anemia,  periph- 
eral neuritis,  and  various  cutaneous  lesions. 

In  the  treatment  of  acute  systemic  arsenical  poisoning,  emetics 
should  be  promptly  given  or  the  stomach  emptied  by  means  of  the 
stomach-pump.  The  best  chemic  antidote  is  freshly  prepared  ferric 
hydroxid  or  ferric  hydroxid  with  magnesia,  administered  while 
moist  in  doses  of  a  tablespoonful  or  more  every  ten  or  fifteen  minutes. 
These  compounds  themselves  are  harmless  and  act  by  forming  insol- 
uble arsenites.  Dialysed  iron  liberates  in  the  stomach  a  certain  amount 
of  free  ferric  hydroxid  and  may  also  be  given.  This  agent  has  also 
been  recommended  in  local  arsenical  poisoning,  but  its  use  here  is 
both  worthless  and  wrong  (see  p.  287).  Demulcents  and  opiates  are 
usually  indicated. 

Therapeutics. — Arsenic  trioxid  is  used  only  in  dental  practice  for 
the  purpose  of  devitalizing  the  pulp  tissue.  The  agent  was  introduced 
to  the  dental  profession  by  Spooner,  of  Montreal,  in  about  1836.  He 
first  advocated  its  use  for  the  treatment  of  sensitive  dentin,  for  he 
discovered  that  by  sealing  the  drug  in  a  cavity  for  a  few  days,  the  most 
sensitive  dentin  yielded  to  its  influence.  The  fact,  however,  that 
nearly  all  teeth  thus  treated  subsequently  gave  trouble  because  of  the 
death  of  the  pulp  and  the  usual  sequelae,  led  the  profession  to  abandon 
this  agent  for  the  purpose  for  which  it  was  introduced;  but  it  has  ever 
since  been  used  as  a  means  of  destroying  the  vitality  of  the  pulp.  In 
fact,  until  the  last  few  years,  it  was  the  only  agent  employed  with  any 
satisfaction.  The  detail  method  of  using  arsenic  troixid  as  a  devitaliz- 
ing agent  will  be  discussed  later. 

CHROMII  TRIOXIDUM— U.  S.  P. 

(Chromium  Trioxid;  Chromic  Acid;  Cr03.) 

Chromium  trioxid,  called  also  chromic  acid,  occurs  in  small, 
crimson  crystals  or  rhombic  prisms.  The  drug  is  without  odor,  very 
deliquescent,  and  thus  freely  soluble  in  water.  It  should  be  kept  in 
glass-stoppered  bottles,  and  great  caution  should  be  observed  to  avoid 
an  explosion  when  brought  in  contact  with  organic  substances,  such  as 
cork,  tannic  acid,  sugar,  alcohol,  glycerin,  ether,  and  collodion. 


OSMII    TETROXIDLM       POTASSD    ET    SOIMI.  97 

Physiologic  Action  and  Therapeutics.— Chromic  acid  is  an 
active  escharotic,  clue  to  its  powerful  oxidizing  influence.  Internally 
administered,  it  causes  intense  pain  in  the  abdomen,  vomiting  and 
purging,  oftentimes  with  blood  in  the  vomited  matter  and  stools, 
ultimate  collapse,  and  frequent  death.  Alkalies  neutralize  the  com- 
pound, but  the  salts  thus  formed  are  poisonous  and  the  stomach  should 
be  emptied  after  the  administration  of  the  antidote.  Chromium 
trioxid  has  been  employed  for  the  purpose  of  devitalizing  the  pulp 
tissue  in  children's  teeth.  Though  the  agent  may  be  considered  safer 
than  arsenic  trioxid,  because  it  is  less  penetrating,  its  action  is  un- 
certain and  unreliable.  Stevens  recommends  a  solution  of  from 
20-30  gr.  (1.3-2.0  gm.)  to  the  ounce  (30.0  c.c.)  as  a  stimulating  ap- 
plication in  mucous  patches.  The  fused  crystals  on  a  suitable  probe 
may  be  used  with  excellent  results  in  the  removal  of  hypertrophied  gum 
or  pulp  tissue,  and  in  closing  small  salivary  fistulce. 

Incompatibles. — With  organic  substances,  such  as  cork,  tannic 
acid,  alcohol,  glycerin,  etc.,  chromic  trioxid  easily  explodes. 

Potassium  Dichromate  (K2C207). — This  salt,  sometimes  called 
potassium  bichromate,  may  be  employed  in  weak  solutions  (5  per 
cent.)  in  indolent  ulcers,  mucous  patches  and  sloughing  wounds. 

OSMII  TETROXIDUM. 

(Osmium  Tetroxid;  Osmic  Acid;  Os04). 

Osmium  tetroxid,  called  also  osmic  acid,  occurs  in  yellow,  crys- 
talline needles,  possessing  a  pungent  odor  and  burning  taste.  It  is 
freely  soluble  in  water,  alcohol,  and  ether. 

Physiologic  Action  and  Therapeutics. — This  is  a  very  irritant 
and  caustic  agent.  When  injected  into  the  tissues,  even  in  weak 
solutions,  the  blood  and  tissue  turn  black,  but  healing  of  the  wound 
generally  proceeds  without  interruption.  Its  use  has  been  confined  to 
the  treatment  of  neuralgia.  Murphy,  Bennett,  and  others  claim 
excellent  results.  The  affected  nerve  is  exposed  by  a  small  incision, 
and  a  1.5  per  cent,  solution,  freshly  prepared,  is  injected  into  its  sub- 
stance at  different  points,  to  the  amount  of  from  5-10  min.  (0.3-0.6  c.c.) . 

POTASSII  ET  SODII— Unofficial. 
(Kalium  and  Natrium;  Potassium  and  Sodium;  K  and  Na. 

Potassium  and  sodium  are  known  in  chemistry  as  alkali-metals; 
they  vigorously  decompose  water  at  ordinary  temperatures,  forming  the 
hydroxid  (hydrate)  of  the  metal,  with  liberation  of  hydrogen.     The 

7 


98  ESCHAROTICS    OR    CAUSTICS. 

metals  occur  in  soft  cylinders,  having  a  silver-white  color;  and  on 
account  of  their  tendency  to  combine  with  oxygen  they  must  be  kept 
under  a  hydrocarbon  liquid,  such  as  coal-oil,  benzene,  etc. 

Action  and  Therapeutics. — Because  of  their  violent  action  on 
soft  tissue  they  are  not  used  as  such  in  medicine.  Schreier,  of  Vienna, 
introduced  a  mixture  of  these  metals  as  a  remedy  for  treating  putres- 
cent root-canals.  When  the  mixture  is  placed  in  a  canal  containing 
dead  pulp  tissue  a  violent  reaction  takes  place,  water  is  decomposed, 
with  the  evolution  of  considerable  heat,  and  the  hydroxids  of  the 
metals  are  formed.  The  potassium  and  sodium  hydroxids  unite  with 
the  fatty  products  present  to  form  soluble  soap,  which  may  be  removed 
by  washing.  Thus  it  will  be  seen  that  the  contents  of  the  canal  are 
chemically  destroyed  and  physically  removed,  leaving  the  canal  white 
and  clean.  Rhein  recommends  a  further  sterilization  of  the  canal 
with  a  1 :  500  solution  of  mercury  bichlorid  in  a  3  per  cent,  solution 
of  hydrogen  dioxid. 

POTASSII  HYDROXIDUM— U.  S.  P. 

(Potassium  Hydroxid;  Caustic  Potash;  KOH). 

Potassium  hydroxid,  more  commonly  called  caustic  potash, 
occurs  in  hard,  white,  translucent  pencils  or  fused  masses,  odorless,  and 
having  an  acrid  and  caustic  taste.  It  is  freely  soluble  in  water  and  in 
alcohol.     The  official  preparation  is: 

Liquid  Potassii  Hydroxidi,  U.  S.  P.  (5  per  cent.). 

SODII  HYDROXIDUM— U.  S.  P. 

(Sodium  Hydroxid;  Caustic  Soda;  NaOH). 

Sodium  hydroxid,  or  caustic  soda,  occurs  in  hard,  white,  trans- 
lucent pencils  or  fused  masses,  odorless,  and  having  an  acrid  and  caustic 
taste.  It  is  freely  soluble  in  water  and  in  alcohol.  The  official  prepa- 
ration is: 

Liquor  Sodii  Hydroxidi,  U.  S.  P.  (5  per  cent.). 

Physiologic  Action  and  Therapeutics. — The  action  of  caustic 
potash  and  caustic  soda  is  similar.  They  may  be  classed  among  the 
strongest  and  most  penetrating  escharotics  known.  They  should  be 
handled  about  the  mouth  and  other  soft  tissues  with  the  greatest  cau- 
tion. Their  action  is  both  rapid  and  painful.  When  applied  to  soft 
tissue  they  produce  a  slough  which  separates  in  a  few  days  leaving  a 
granulating  ulcer.     The  escharotic  effect  is  caused  by  the  abstraction 


HYDROFLUORIC   ACID.  99 

of  water  from  the  tissues;  this  softens  the  hitter,  and  the  hydroxyl 
radical  forms  with  the  proteids  a  soluble  alkaline  albuminate.  AYhen 
either  are  taken  internally  in  large  doses  they  produce  all  the  symptoms 
of  corrosive  poisoning — burning  in  the  throat  and  esophagus,  intense 
pain  in  abdomen,  vomiting  and  purging  of  mucous  and  bloody  matter, 
dysphagia,  and  ultimate  collapse.  Small  doses  freely  diluted  have  the 
same  action  as  the  alkaline  carbonates — that  of  an  antacid. 

Caustic  potash  and  caustic  soda  are  sometimes  employed  in 
dental  practice  to  destroy  exuberant  granulations.  They  are  also  used 
in  about  10  per  cent,  solutions  to  cauterize  and  destroy  a  remnant  of 
a  pulp.  Whenever  these  alkalies  are  employed  in  the  canals  of  teeth, 
care  must  be  taken  so  as  not  to  force  them  through  the  root  end,  and 
their  caustic  action  should  be  neutralized  with  weak  acids. 

Treatment  of  Poisoning. — The  treatment  of  poisoning  with 
the  caustic  alkalies  to  be  effective  must  be  prompt.  Dilute  acetic 
acid  or  vinegar  will  neutralize  the  alkali  and  should  be  given  at  once. 
Demulcent  drinks  are  indicated  to  soothe  the  corroded  parts,  and 
opium  to  control  the  pain. 

Hydrofluoric  Acid  (HF).— This  is  a  colorless  gas,  freely  soluble  in 
water.  It  may  be  obtained  commercially  in  solution,  and  because  of 
its  power  to  etch  glass,  it  must  be  kept  in  rubber  or  gutta-percha 
bottles.  On  account  of  its  extremely  irritating  and  penetrating  prop- 
erty, it  is  not  employed  as  a  therapeutic  agent,  but  is  used  extensively 
in  dentistry  for  etching  porcelain  inlays.  It  must  be  handled  with  the 
greatest  care,  for  if  it  is  accidentally  applied  to  the  soft  tissue  and  not 
instantly  neutralized  it  will  penetrate  deeply  and  produce  an  ugly  ulcer. 
Many  cases  of  severe  local  poisoning  by  the  agent  have  been  reported, 
and  it  is  for  this  reason  largely  that  it  has  been  included  in  this  work 
on  therapeutics. 

The  treatment  of  local  poisoning  consists  in  neutralizing  the 
drug  chemically  by  the  use  of  alkalies.  A  weak  solution  (5  per  cent.) 
of  ammonia  water  serves  the  purpose  nicely,  and  the  sooner  the  appli- 
cation is  made  after  the  discovery  of  the  burn,  the  less  destruction  of 
tissue  there  will  be.  To  apply  the  antidote,  the  part  can  be  wrapped  in 
plain  sterile  gauze  and  this  saturated  with  the  remedy.  The  am- 
monia will  irritate  the  part  and  probably  cause  pain,  but  the  acid 
must  be  neutralized,  even  at  the  expense  of  causing  pain.  After  we 
are  reasonably  certain  that  the  acid  is  neutralized,  the  burn  should  be 
antiseptically  treated  in  the  usual  way.  The  euroform  paste  is  an 
excellent  remedy  to  employ. 

Actual  Cautery. — The    cauterization    of    tissue    by    means    of 


IOO  IRRITANTS   AND    COUNTERIRRITANTS. 

heat  should  be  considered  briefly  under  the  heading  of  Escharotics. 
This  is  accomplished  by  means  of  the  hot  iron  or  the  galvano-cautery, 
and  affords  a  prompt  and  powerful  means  of  destroying  tissue. 
Though  not  as  painful  as  one  would  naturally  suppose,  the  process 
is  seldom  employed  to-day  in  dentistry. 

IRRITANTS  AND  COUNTERIRRITANTS. 

Irritants  have  been  elsewhere  defined  as  agents  which,  when 
applied  to  the  skin  or  mucous  membrane  of  the  mouth,  produce  active 
hyperemia  or  inflammation.  When  irritants  are  applied  to  a  normal 
part  for  the  purpose  of  influencing  favorably  a  diseased  part,  usually 
deep-seated,  they  are  called  counterirritants,  and  the  process  counter- 
irritation.  It  is  for  this  latter  purpose  that  irritants  are  largely  employed 
in  dentistry.  The  extent  to  which  counterirritation  may  be  carried 
depends  upon  the  severity  of  the  diseased  part  which  the  irritation  of 
the  normal  part  is  intended  to  influence.  The  agents  used  are  sub- 
divided into  different  classes  according  to  the  degree  of  irritation 
following  their  application.  Those  which  simply  produce  active 
hyperemia  (redness)  of  the  surface  are  called  rubefacients;  those  which 
act  more  severely  and  cause  the  formation  of  a  blister  are  known  as 
vesicants  or  episplastics .  In  many  instances  the  same  agent  may 
produce  a  rubefacient  or  a  vesicant  effect,  depending  upon  the  strength 
of  the  drug  and  the  duration  of  its  application. 

Counterirritation  may  be  carried  to  a  greater  degree  of  intensity 
when  a  true  escharotic  effect  (destruction  of  tissue)  is  produced.  This, 
however,  is  seldom  necessary  in  dental  practice.  In  fact,  as  a  rule, 
it  should  be  guarded  against,  for  the  formation  of  an  ulcer  in  the  mouth 
is  liable  to  so  cripple  the  cells  that  a  mixed  infection  may  readily  follow. 

Care  should  be  exercised  in  the  application  of  counterirritants 
when  the  inflammation  is  superficial.  To  apply  an  irritant  directly 
to  an  inflamed  part  would  only  tend  to  aggravate  the  condition.  Here 
the  site  of  application  should  be  a  short  distance  from  the  diseased 
part.  In  all  deep-seated  inflammations,  or  in  cases  of  neuralgia,  it 
is  best  to  make  the  application  directly  over  the  affected  part. 

Long1  states  that  "the  remedial  effect  of  a  counterirritant  is 
probably  brought  about  by  a  threefold  action.  They  influence,  first, 
the  circulation  by  causing  a  hyperemia  at  the  point  of  irritation,  the 
tendency  of  the  blood  supply  will  be  in  that  direction  and  away  from 
the  original  disease;  second,  they  turn  the  attention  of  the  system 

1  Dental  Materia  Meclica,  Therapeutics  and  Prescription  Writing. 


CAPSICUM.  IOI 

toward  the  new  point  of  irritation  and  away  from  the  disease,  partly  a 
mental  effect;  and,  third,  they  influence  the  innervation  of  the  diseased 
part  by  the  reflex  influence  of  the  irritation.  In  the  sum  of  their  effects 
they  stimulate  the  movement  of  fluids  within  the  tissues;  hence  they 
are  regarded  as  lymphatic  stimulants,  and  are  often  employed  to  stimu- 
late the  absorption  of  a  serous  or  inflammatory  exudate." 

Counterirritation  may  be  said  to  be  truly  indicated  in  dental 
practice  in  the  treatment  of  pericementitis,  and  trigeminal  neuralgia. 

The  most  important  irritants  used  in  dentistry  for  counterirri- 
tation are: 

Heat.  Cantharides. 

Iodin.*  Chloroform. 

Capsicum.  Aconite. 

Mustard.  Camphor. 

Oil  of  Turpentine.  Volatile  Oils. 
Menthol. 

Heat. — This  physical  agent  occupies  a  prominent  place  „in 
dentistry  as  a  counterirritant,  because  of  the  convenience  of  the  variety 
of  forms  and  the  different  degrees  in  which  it  can  be  utilized.  Mod- 
erate heat  applied  over  a  deep-seated  inflammation  will  at  once  produce 
active  hyperemia.  The  heat  may  be  gradually  carried  to  a  higher 
degree  with  comfort  to  the  patient  until  the  serum  escapes  from  the  en- 
gorged blood-vessels,  thus  promoting  resolution.  Hot  water,  the  hot- 
water  bag,  hot  foot-bath,  and  dry  and  moist  poultices,  are  all  employed 
in  various  manners  in  the  treatment  of  pericementitis,  and  acute  alveolar 
abscess. 

CAPSICUM— U.  S.  P. 

(Cayenne  Pepper.) 

Capsicum  is  the  dried  ripe  fruit  of  Capsicum  fastigiatum,  a  plant 
growing  in  tropical  America,  in  Asia,  in  Africa,  and  cultivated  in 
gardens.  The  active  principle  is  capsicin,  which  appears  in  the  form 
of  colorless  crystals  and  has  an  exceedingly  pungent  odor;  other  con- 
stituents are  a  volatile  alkaloid,  fixed  and  volatile  oil,  and  fatty  acids. 
The  dose  is  from  1-3  gr.  (0.06-0.2  gm.).  All  of  the  official  prepara- 
tions may  be  used  in  dentistry.     They  are: 

Tinctura  Capsici,  U.  S.  P.     Dose,  10-20  min.  (0.6-1.3  c-c-)- 
Fluidextractum  Capsici,  U.  S.  P.     Dose,  1-2  min.  (0.06-0. 12  c.c). 
Oleoresina  Capsici,  U.S. P.    Dose,  1/4-1  min.  (0.016-0.06  c.c.) 
Emplastrum  Capsici.  U.  S  P.  (externally) 


102  IRRITANTS   AND    COUNTERIRRITANTS. 

Physiologic  Action. — Applied  to  the  skin  or  mucous  membrane, 
capsicum  produces  a  burning  sensation  and  results  in  a  rubefacient  or 
vesicant  effect  depending  upon  the  concentration  of  the  drug.  Taken 
internally,  in  medicinal  doses,  it  creates  a  sense  of  warmth  in  the 
stomach,  stimulates  the  circulation,  and  aids  the  digestive  process.  In 
large  doses  it  acts  as  an  irritant  poison. 

Therapeutics. — Capsicum  is  used  chiefly  as  a  rubefacient, 
stomachic,  and  carminative.  In  dentistry  advantage  is  taken  of  its 
irritant  properties,  and  it  is  largely  employed  as  a  counterirritant  in 
pericementitis.  The  oleoresin  is  the  most  irritating  preparation. 
The  official  plaster  may  be  prepared  by  spreading  the  oleoresin 
upon  resin  plaster;  this  may  be  cut  in  convenient  form  and  applied  to 
the  dried  gum  over  the  affected  tooth,  resulting  in  a  small  blister, 
but  having  a  beneficial  effect  upon  the  deep-seated  inflammation. 
When  a  rubefacient  effect  only  is  desired,  the  powdered  drug  may  be 
confined  in  small  concave  rubber  disks  and  pressed  on  the  gum,  the 
suction  holding  the  remedy  in  place. 

SINAPIS  ALBA— U.  S.  P. 

(White   Mustard.) 

SINAPIS  NIGRA— U.  S.  P. 

(Black    Mustard.) 

White  mustard  is  the  seed  of  Sinapis  alba.  Black  mustard  is 
the  seed  of  Brassica  nigra.  Both  of  these  herbs  are  cultivated  exten- 
sively in  Europe  and  America.  The  powdered  mustard  of  commerce 
is  a  ground  mixture  of  white  and  black  seed,  often  more  or  less  adulter- 
ated. Mustard  in  the  dry  state  is  not  irritating,  but  in  the  presence  of 
water  it  is  extremely  irritating,  and  for  this  reason:  White  mustard 
contains  a  ferment,  myrosin,  and  a  glucosid,  sinalbin.  In  the  presence 
of  water  the  myrosin  acts  upon  the  sinalbin  and  separates  from  it  an 
irritant  volatile  oil. 

Black  mustard  contains  the  same  ferment,  myrosin,  and  a  glucosid, 
sinigrin,  which  by  the  action  upon  it  of  the  ferment  in  the  presence  of 
water  also  converts  it  into  an  intensely  irritant  volatile  oil.  This  oil 
of  mustard  is  official,  and  to  it  is  due  both  the  pungent  taste  and  odor 
of  the  moistened  powder.  Dose,  1-4  drams  (4.0-16.0  gm.).  The 
following  preparations  are  official : 

Charta  Sinapis,  U.  S.  P. 

Oleum  Sinapis  Volatile,  U.  S.  P.  (Volatile  Oil  of  Mustard). 


TER1   I'.IN  I  1IINA.  IO3 

Physiologic  Action.  Mustard  made  into  a  paste  with  water 
and  applied  to  the  skin  or  applied  to  the  moist  mucous  membrane 
causes  redness,  heat,  and  a  burning  pain.  Any  degree  of  irritation, 
from  a  slight  rubefacient  effect  to  severe  vesication,  may  be  produced. 
It  should  be  remembered  that  the  presence  of  moisture  is  necessary 
for  the  irritant  action  of  mustard,  the  dry  powder  is  not  irritating. 
Hot  water  should  not  be  used,  as  the  high  heat  tends  to  destroy  the 
ferment  necessary  to  evolve  the  irritating  oil  from  the  glucosid. 

Taken  internally  in  small  doses,  mustard  acts  as  a  carminative. 
In  large  doses  it  acts  as  an  emetic,  producing  prompt  emesis  without 
depression,  owing  to  the  reflex  stimulation  of  the  cardiac  and 
respiratory  centers. 

Therapeutics. — Mustard  is  useful  in  dentistry  as  a  rubefacient. 
The  official  paper,  cut  in  proper  form,  may  be  applied  to  the  moist 
gum  in  nonseptic  pericementitis.  Concave  rubber  cups  may  also  be 
used  and  applied  by  suction.  Powdered  mustard  may  be  added  to 
warm  water  to  bring  about  the  reaction  necessary  to  produce  the  ir- 
ritant volatile  oil,  and  this  added  to  the  hot  water  in  taking  a  hot  foot- 
bath for  counterirritant  purposes.  To  add  the  mustard  direct  to  the 
hot  water  would  defeat  the  object  for  which  the  drug  is  used,  as  the  heat 
checks  the  action  of  the  ferment. 

On  account  of  the  prompt  emetic  properties  of  mustard  the  drug 
may  be  employed  in  cases  of  narcotic  poisoning,  the  dose  being  a 
tablespoonful  stirred  up  in  warm  water,  and  repeated  in  fifteen  min- 
utes, if  necessary. 

The  drug  is  sometimes  used  in  neuralgia  and  muscular  rheumatism. 
The  blisters  •  produced  by  mustard  heal  with  difficulty;  therefore, 
extensive  vesication  should  be  guarded  against. 

TEREBINTHINA— U.  S.  P. 

(Turpentine.) 

Turpentine  is  a  solid  oleoresin,  or  pitch,  obtained  from  Finns 
palustris  and  other  species  of  Pinus,  growing  in  the  Southern  United 
States,  especially  in  North  Carolina.  The  oleoresin  exudes  from  the 
pine  tree  when  the  bark  is  cut,  and  when  subjected  to  distillation  it 
yields  a  volatile  oil,  which  is  official,  and  a  solid  residue  called  resin  or 
rosin,  also  official. 

OLEUM  TEREBINTHINA— U.  S.  P. 

Oil  of  turpentine  is  a  thin,  colorless  liquid,  highly  inflammable, 
and  of  a  characteristic  odor  and  taste.     It  should  be  kept  in  well- 


104  IRRITANTS    AND    COUNTERIRRITANTS. 

stoppered  bottles,  protected  from  light.  The  rectified  oil  is  made  by 
distilling  the  ordinary  oil  with  lime-water.  This  is  the  preparation 
which  is  largely  used  in  dentistry  and  the  one  always  used  for  in- 
ternal medication.  Dose  is  from  5-15  min.  (0.3-1.0  c.c.)  in  emulsion. 
The  official  preparations  are: 

Oleum  Terebinthinae  Rectificatum,  U.  S.  P. 
Emulsum  Olei  Terebinthinae,  U.  S.  P.  (15  per  cent.). 
Liniment   Terebinthinae,    U.    S.    P.    (35  per  cent,  with  Resin 
Cereate) . 

Physiologic  Action. — When  applied  to  the  skin,  the  drug  dilates 
the  cutaneous  blood-vessels,  producing  a  sensation  of  heat  and  redness, 
and,  if  continued  long,  vesication  follows.  The  drug  has  decided 
antiseptic  properties,  and  even  in  dilute  solutions  prevents  fermenta- 
tion and  putrefaction.  Taken  internally  in  medicinal  doses,  it  pro- 
duces warmth  in  the  stomach,  quickened  repiration,  and  increases  the 
rate  and  tension  of  the  pulse.  It  also  acts  as  a  circulatory  stimulant 
and  diuretic. 

In  large  doses  it  produces  all  the  symptoms  of  an  irritant  poison. 
Some  individuals  are  peculiarly  susceptible  to  the  drug,  and  erythem- 
atous or  papular  eruption  may  result  from  either  its  internal  or  ex- 
ternal use. 

Therapeutics. — Externally,  oil  of  turpentine  may  be  used  as  a 
rubefacient  in  various  inflammatory  affections.  In  an  acute  alveolar 
abscess  a  turpentine  stupe  may  be  employed  to  advantage.  The  latter 
is  made  by  soaking  a  large  piece  of  flannel  in  boiling  water  and  wringing 
dry  and  folding  it  several  times  until  it  is  about  six  inches  square,  then 
from  10  to  30  drops  of  the  oil  is  distributed,  when  it  should  be  quickly 
applied  to  the  cheek  of  the  affected  side  and  covered  with  several 
layers  of  fabric.  The  official  liniment  makes  an  excellent  remedy  to  be 
applied  in  cases  of  neuralgia  and  muscular  rheumatism. 

TEREBENUM— U.  S.  P. 

(Terebene.) 

This  is  a  liquid  hydrocarbon  made  by  oxidizing  oil  of  turpentine 
with  strong  sulphuric  acid.     The  dose  is  from  5-10  min.  (0.3-0.6  c.c). 

Terebene  has  proved  to  be  a  very  satisfactory  remedy  in  bronchitis 
with  free  expectoration.  It  has  also  been  used  in  phthisis,  and  may  be 
inhaled  from  a  spray  or  from  the  sponge  of  a  respirator.  Harlan 
recommended  its  use  for  putrescent  root-canals;  but,  like  the  essential 
oils,  its  use  here  is  unreliable. 


CANTHAKIS.  IO5 

CANTHARIS  -U.  S.  P. 

(Cantharides;  Spanish  Flies.) 

Cantharides,  commonly  called  Spanish  fly,  is  the  dried  and  pow- 
dered beetle  ovn  insect,  Cantharis  vesicatoria,  indigenous  to  Southern 
and  Central  Europe.  The  active  principle  is  cantharidin,  which  is 
also  found  in  a  number  of  beetles.  The  drug  is  used  only  externally 
in  dentistry.     The  official  preparations  are: 

Tinctura  Cantharidis,  U.  S.  P. 
Ceratum  Cantharidis,  U.  S.  P. 
Collodium  Cantharidatum,  U.  S.  P.  (60  per  cent.). 

Physiologic  Action. — Cantharides  is  a  powerful  irritant,  though 
rather  slow  in  its  action.  When  applied  to  the  skin  or  mucous  mem- 
brane, the  drug  excites  a  tingling  and  burning  sensation,  producing 
redness  and,  later,  vesication.  Its  long-continued  application  often 
results  in  pustulation,  ulceration,  and  sloughing. 

Butler  states  that  the  drug  not  only  causes  vascular  dilatation 
of  the  part  to  which  it  is  applied,  but  reflexly  dilates  the  blood-vessels 
of  the  deep-seated  organs  underneath,  thus  acting  as  a  counterirritant. 

The  active  principle,  cantharidin,  may  be  absorbed  through  the 
unbroken  skin,  and  is  quite  readily  absorbed  through  the  mucous 
membrane,  thus  its  constitutional  effects  may  result  from  the  external 
use  of  the  drug.  The  toxic  symptoms  are  great  pain  in  the  throat, 
stomach,  and  bowels,  excessive  thirst,  irritation  of  the  genitourinary 
tract  with  a  desire  to  urinate  constantly,  albuminous  and  bloody  urine, 
painful  erections  of  the  penis  in  males,  and  in  women  abortion  may 
follow  the  irritant  effect  of  the  drug  upon  the  pelvic  viscera.  While 
these  symptoms  are  not  liable  to  follow  the  use  of  the  drug  in  dental 
practice  where  a  limited  area  is  selected  as  the  site  of  application  for 
counterirritant  purposes  it  is,  nevertheless,  well  to  be  familiar  with 
them. 

Treatment  of  Poisoning. — The  stomach  should  be  emptied, 
and  demulcents  given  freely  to  relieve  the  irritation.  Opium  may  be 
required  to  relieve  the  pain,  and  stimulants  administered,  if  necessary. 
Oils  and  fatty  substances  dissolve  the  cantharidin,  and  thus  hasten 
its  absorption;  they  should  therefore  be  avoided  as  demulcents. 

Therapeutics. — Cantharides  may  be  used  as  a  counterirritant 
in  cases  of  severe  pericementitis,  and  as  it  dilates  the  arterioles  sub- 
jacently,  the  effect  of  the  drug  will  ultimately  afford  relief.  Its  action 
is  slow  but  certain.     The  cereate  may  be  applied  as  a  plaster  or  the 


106  IRRITANTS   AND    COUNTERIRRITANTS. 

collodion  as  a  varnish.  To  insure  greater  activity  of  the  drug,  the 
site  of  application  should  be  oiled.  In  facial  neuralgia  cantharides 
is  valuable,  the  preparation  being  applied  behind  the  ear. 

ACONITUM— U.  S.  P. 

(Aconite;  Wolfsbane;  Monkshood.) 

Aconite  is  official  in  the  form  of  the  dried  tuberous  root  of 
Aconitum  napellus,  a  plant  growing  in  Europe,  Asia,  and  in  America, 
mostly  in  mountainous  regions.  The  root  closely  resembles  horse- 
radish; the  latter,  however,  has  a  pungent  odor  when  scraped,  while 
aconite  is  odorless.  The  root  at  first  has  a  sweetish  taste,  but  soon 
produces  a  sense  of  warmth  and  tingling,  followed  by  numbness.  The 
active  principle  is  aconitin,  also  official  under  the  title  aconitina, 
U.  S.  P.  This  is  an  alkaloid,  occurring  in  colorless  or  white  rhombic 
prisms  or  prismatic  powder,  without  odor,  and  permanent  in  the  air, 
and  when  brought  in  contact  with  the  mucous  membrane,  even  in 
dilute  solutions,  produces  a  characteristic  tingling  and  more  or  less 
anesthesia.  The  dose  of  aconitin  is  from  1/500-1/ 200  gr.  (0.00013- 
0.0003  gm0-     The  official  preparations  of  aconite  are: 

Tinctura  Aconiti,  U.  S.  P.  (10  per  cent.;  35  per  cent.,  U.  S.  P., 

1890.)     Dose,  5-15  min.  (0.3-1 .0  c.c.) 

Fluidextractum  Aconiti,   U.  S.  P.     Dose,   1-2   min.  (0.06-0.12 

c.c.) 

Linimentum  Aconiti  (not  official;  externally). 

Physiologic  Action. — Aconite  is  a  true  circulatory  depressant. 
It  may  also  be  considered  a  nervous  sedative.  Applied  to  the  mucous 
membrane  or  to  the  skin  for  any  length  of  time,  it  first  irritates,  causing 
stimulation,  and  then  depresses  the  sensory  nerve-endings,  producing, 
respectively,  tingling,  numbness,  and  local  analgesia.  The  drug  lowers 
the  blood  pressure  by  directly  depressing  the  heart.  In  the  febrile 
state,  moderate  doses  of  aconite  cause  a  decided  fall  of  temperature] 
Butler  claims  this  is  due  to  various  causes:  (1)  The  slowing  of  the 
circulation,  diminishing  the  metabolism;  (2)  the  peripheral  action 
of  the  drug,  causing  dilatation  of  the  cutaneous  blood-vessels;  (3) 
the  depressant  action  upon  all  muscle-tissue. 

Toxicology. — Poisoning  by  aconite  is  first  manifested  by  a  pecu- 
liar tingling  sensation  of  the  tongue  and  lips,  soon  extending  to  the 
fingers,  and  may  affect  the  entire  surface  of  the  skin.  The  pulse  be- 
comes slow  and  weak,  later  it  may  become  rapid  and  irregular;  the 


CAMPHORA.  IO7 

respiration  is  slow  and  feeble.  There  is  an  extreme  muscular  weak- 
ness, especially  noticeable  in  the  lower  extremities. 

Treatment  of  Poisoning. — The  patient  should  be  kept  in  a 
recumbent  position,  the  feet  slightly  raised.  The  stomach  should  be 
thoroughly  emptied,  keeping  patient  in  this  position.  External  applica- 
tions of  heat  should  be  made  to  raise  the  temperature,  and  diffusible 
stimulants,  such  as  alcohol  and  aromatic  spirit  of  ammonia,  should 
be  given;  strychnin,  atropin,  and  digitalis  may  be  hypodermically 
administered  for  their  effect  upon  the  cardiac  and  respiratory  centers; 
and,  if  necessary,  artificial  respiration  should  be  employed. 

Therapeutics. — Though  the  first  effect  of  aconite,  locally  applied, 
is  that  of  an  irritant,  it  has  not  been  discussed  here  because  of  this 
property;  but  rather  for  the  reason  that  certain  preparations  of  the 
drug,  notably  the  tincture,  have  long  been  used  in  dental  practice  as 
a  constituent  of  counterirritant  remedies  for  the  treatment  of  apical 
pericementitis  and  facial  neuralgia.  Tincture  of  aconite  has  been 
extensively  used  to  dilute  the  tincture  of  iodin  for  dental  purposes. 
A  favorite  liniment  of  the  author's  for  nonseptic  pericementitis  is: 
Menthol,  20  gr.;  chloroform,  1  1/2  fl.  dr.;  tincture  of  aconite,  6  1/2 
fl.  dr.     The  therapeutics  of  aconite  will  be  discussed  more  fully  later. 


CAMPHORA— U.  S.  P. 

(Camphor;  C10Hl60.) 

Camphor  is  a  stearopten  obtained  from  Cinnamomnm  camphora, 
a  tree  indigenous  to  Eastern  and  Southeastern  Asia,  and  cultivated 
in  Italy  as  an  ornamental  tree.  The  drug  occurs  in  white,  translucent 
masses,  of  a  tough  consistence  and  crystalline  structure,  readily  pulver- 
izable  in  the  presence  of  a  little  alcohol,  ether,  or  chloroform.  It  is 
sparingly  soluble  in  water,  but  freely  soluble  in  alcohol,  ether,  chloro- 
form, fixed  and  volatile  oils.  When  camphor  is  triturated  in  about 
equal  proportions  with  menthol,  thymol,  phenol,  or  chloral  hydrate,  a 
syrupy  liquid  results.  The  dose  is  from  1-5  gr.  (0.06-0.3  gm.).  The 
following  preparations  are  official: 

Aqua  Camphors,  U.  S.  P. 

Cereatum  Camphorae,  U.  S.  P.  (10  per  cent.). 

Linimentum  Camphorae,  U.  S.  P.  (30  per  cent,  in  Cottonseed  Oil). 

Linimentum  Saponis,  U.  S.  P.  (4.5  per  cent.). 

Spiritus  Camphorae,  U.  S.  P.  (10  per  cent.). 

Tincturas  Opii  Camphorata,  U.  S.  P.  (Camphorated  Tincture  of 

Opium;  Paregoric;  0.4  per  cent.).     Dose,  1-4  fl.  dr.  (4-16  c.c). 


.To8  EMOLLIENTS,    DEMULCENTS,    AND   PROTECTIVES. 

Physiologic  Action. — Upon  the  unbroken  skin,  camphor  acts 
•as  an  anesthetic;  but  on  the  mucous  membrane  it  is  irritating,  and  in 
concentrated  form  may  produce  inflammation  and  even  sloughing. 
In  medicinal  doses  it  acts  as  a  carminative  and  antispasmodic.  In 
large  doses,  it  causes  confusion  of  thought,  headache,  gastric  irritation, 
-a  rapid  feeble  pulse,  convulsions,  and  collapse. 

Therapeutics. — Camphor  is  used  as  a  rubefacient,  circulatory 
stimulant,  and  antispasmodic.  The  spirit  of  camphor  has  long  been 
•a  household  remedy  for  Jieadache,  syncope,  and  faintness.  It  is  ad- 
ministered by  inhalation;  camphorated  oil  (5  per  cent,  of  camphor  in 
olive  oil)  is  a  useful  remedy  in  colds  and  croup.  The  liniment,  as  well 
as  the  spirit,  is  extensively  used  in  sprains,  bruises,  muscular  rheumatism, 
and  neuralgia.  Prinz  advocates  a  combination  of  thymol  (2  parts), 
phenol  crystals  (2  parts),  and  camphor  (1  part),  called  thymocamphene, 
as  an  anodyne  in  root-canal  treatment.  In  acute  coryza,  Stevens  recom- 
mends adding  a  teaspoonful  of  powdered  camphor  to  a  tumbler  of  hot 
water,  and  inhaling  the  fumes. 

EMOLLIENTS,  DEMULCENTS,  AND  PROTECTIVES. 

Emollients  are  substances  of  a  fatty  nature  which  soften  and  re- 
lax the  tissue  to  which  they  are  applied,  and  at  the  same  time  shield 
the  part  from  external  irritation. 

The  most  important  emollients  are: 

Glycerin.  Fats  and  Oils: 

Soap  Liniment.  Lard. 

Starch.  Olive  Oil. 

Hot  Fomentations.  Almond  Oil. 

Poultices:  Linseed  Oil. 

Linseed  Meal.  Lanolin. 

Oatmeal.  Petrolatum. 

Bran.  Paraffin. 

Bread.  Cacao  Butter. 

Flour.  Wax. 

Figs,  etc. 

Demulcents  are  substances  largely  of  a  mucilaginous  character 
which  soothe  and  protect  the  tissues  to  which  they  are  applied.  The 
important  demulcents  are: 

Acacia.  Marshmallow. 

Tragacanth.  White  of  Egg. 

Licorice  Root.  Sassafras  Pith. 

Flax  Seed.  Slippery  Elm. 


GLM   I   KIM'M.  IO9. 

Protectives  arc  agents  used  to  mechanically  cover  and  protect 
injured  or  diseased  surfaces  from  extraneous  influences,  as  air,  water, 
bacteria,  etc.  Some  protectives,  besides  affording  mechanical  pro- 
tection to  the  part,  also  absorb  moisture  or  fluids  by  capillary  attrac- 
tion. The  so-called  dusting  powders  and  fixed  dressings  are  included 
in  this  group.     The  chief  protectives  are: 

Collodion.  Talc. 

Solution  of  Gutta-percha.  Kaolin. 

Court  Plaster.  Lycopodium. 

Charcoal.*  Zinc  Oxid.* 

Animal  Charcoal.*  Chalk.* 

Purified  Cotton.  Magnesium  Carbonate.* 

Emollient  and  demulcent  are  largely  interchangeable  terms,  and 
no  distinct  division  between  the  substances  used  as  such  can  be  made. 
The  emollient,  demulcent,  and  protective  agents  will,  therefore,  be  dis- 
cussed here  without  reference  to  the  three  subdivisions  into  which 
they  have  been  grouped. 

GLYCERINUM— U.   S.  P. 

(Glycerin;  C3Hs(OH)3.) 

Glycerin  is  a  syrupy  liquid  obtained  by  the  decomposition  of  fats 
and  fixed  oils.  It  is  clear,  colorless,  without  odor,  of  a  sweetish,  warm 
taste,  and  when  exposed  to  the  air  slowly  absorbs  moisture.  Freely 
soluble  in  water  and  alcohol,  but  insoluble  in  ether,  chloroform,  and 
oils.  Chemically  considered,  it  is  an  alcohol.  Dose  is  from  1-2  fl.  dr. 
(4-8  c.c).     The  following  preparations  are  official: 

Glyceritum  Phenolis,  U.  S.  P.  (20  per  cent,  of  Phenol). 

Glyceritum  Acidi  Tannici,  U.  S.  P.  (20  per  cent.  Tannic  Acid). 

Glyceritum  Amyli,  U.  S.  P.  (Starch,  10;  Water,  10;  Glycerin,  80). 

Glyceritum  Boroglycerini,  U.  S.  P.  (50  per  cent,  of  Boroglycerin). 

Glyceritum  Hydrastis,  U.  S.  P.  (1  c.c.  of  preparation  contains 

1  gm.  of  Hydrastis). 

Glyceritum  Ferri,  Quininae,  et  Strychinae  Phosphatum,  U.  S.  P. 

Dose,  10-30  min  (  0.6-2.  o  c.c). 

Gelatinum  Glycerinatum,  U.  S.  P.  (equal  parts  of  Gelatin  and 

Glycerin). 

Suppositoria   Glycerini,    U.  S.  P.   (each   Suppository   contains 

45  f-?~Z-°  gm-  °f  Glycerin  gelatinized  by  means  of  a  Sodium 

Soap). 

Cataplasma  Koalini,  U.  S.  P.  (Kaolin,  57.7  parts;  Glycerin,  37.5 

parts;  Boric  Acid,  4.5  parts;  Methyl  Salicylate,  2  parts;  Thymol 

and  Oil  of  Peppermint,  each  1/2  part). 


IIO  EMOLLIENTS,    DEMULCENTS,    AND    PROTECTIVES. 

Glycerin  is  also  a  constituent  of  many  extracts  and  fluid  extracts, 
added  largely  to  preserve  the  preparations. 

Physiologic  Action. — When  glycerin  is  applied  to  sensitive 
skin  or  mucous  membrane,  it  has  a  tendency  to  irritate,  due  to  the 
abstraction  of  water  from  the  tissues.  Taken  internally,  in  large 
doses,  glycerin  acts  as  a  cathartic,  its  action  here  probably  being  due 
also  to  its  hygroscopic  property.  It  is  antiseptic  in  that  it  inhibits, 
to  an  extent,  microorganic  growth.  Authorities  differ  as  to  whether 
or  not  glycerin  in  moderate  doses  acts  as  a  food. 

Therapeutics. — Externally  applied,  glycerin  is  an  efficient  and 
popular  emollient.  For  chapped  hands  and  after  shaving  the  follow- 
ing lotion  is  valuable:  Witch-hazel  and  bay-rum,  each  i  fl.  oz. 
(30.0  c.c);  glycerin,  1  fl.  oz.  (30.0  c.c);  borax,  1/2  dr.  (2.0  gm.). 
The  official  cataplasm  of  kaolin,  applied  hot,  is  an  excellent  substi- 
tute for  ordinary  poultices  where  the  latter  are  indicated.  In  inflam- 
matory disease  of  the  mouth,  throat,  and  nose,  glycerin  is  used  to  ad- 
vantage as  a  vehicle  for  other  drugs. 

Glycerite  of  boroglycerin  is  a  constituent  of  many  antiseptic 
mouth-washes;  and  glycerite  of  tannic  acid  may  be  added,  1/2  fl.  dr. 
to  the  fl.  oz.  (2  c.c-30.0  c.c),  to  mouth- washes  to  add  astringency. 
Glycerite  of  tannic  acid  may  also  be  applied  to  flabby  and  inflamed 
gums.  The  glycerin  not  only  depletes  the  engorged  capillaries,  but 
also  serves  to  spread  the  drug  contained  therein  over  the  entire  surface. 

Internally  it  is  largely  employed  in  habitual  constipation.  Here 
the  official  suppository  may  be  employed. 

Incompatibles. — Powerful  oxidizing  agents,  like  sodium  dioxid, 
chromic  acid,  and  potassium  permanganate,  explode  with  glycerin. 

AMYLUM— U.  S.  P. 

(Starch;  C6HioOs.) 

Starch  is  a  white  powder,  or  masses,  obtained  from  the  fecula  of 
the  seed  of  Zea  mays,  or  Indian  corn.  Wheat  starch  (flour)  and  rice 
starch  are  also  used  in  therapeutics.  It  is  insoluble  in  water;  soluble  in 
boiling  water.     There  is  only  one  official  preparation: 

Glyceritum  Amyli,  U.  S.  P.  (10  per  cent.). 

Therapeutics. — Starch  is  used  externally  in  the  form  of  dusting 
powder  or  "pastes"  as  protective  applications.  It  is  an  antidote  for 
iodin  poisoning,  the  insoluble  starch  iodid  being  formed. 

In  pharmacy  the  glycerite  of  amyl  is  used  as  an  excipient  for 
making  pill-masses  of  certain  drugs. 


OLEUM    OLIVjE — LINUM.  Ill 

OLEUM  OLIVjE— U.  S.  P. 

(Olive  Oil;  Sweet  Oil.) 

Olive  oil  is  a  fixed  oil  expressed  from  the  ripe  fruit  of  Olea  europea, 
a  shrubby  tree  indigenous  to  western  Asia,  but  cultivated  in  several 
countries,  including  the  southern  United  States,  especially  California. 
The  oil  is  a  pale  yellow  or  light  greenish-yellow  liquid,  of  a  characteristic 
odor,  and  an  oleaginous  taste.  It  should  be  kept  in  well-stoppered 
bottles,  in  a  cool  place.  Dose  i  fl.  oz.  (30.0  c.c).  It  is  a  constituent  of 
unguentum  diachylon,  U.  S.  P. 

Physiologic  Action  and  Therapeutics. — Olive  oil  is  a  bland  and 
agreeable  oil,  and  is  used  extensively  as  an  emollient  and  demulcent. 
It  is  readily  absorbed  from  the  skin  and  mucous  membrane,  and  with 
phenol  (5  per  cent.)  it  makes  a  soothing,  protective  application  for 
superficial  wounds,  bruises,  burns,  insect  bites,  stings,  etc.  Camphor- 
ated olive  oil  (camphor  5  per  cent.)  is  a  useful  remedy  to  rub  on  the 
throat  and  chest  in  cases  of  colds  and  croup  in  children. 

In  cases  of  poisoning  from  corrosive  irritating  drugs,  olive  oil.  is  a 
valuable  demulcent,  unless  the  poison  be  soluble  in  an  oil,  in  which  case 
any  fat  or  oil  is  contraindicated,  as  it  would  tend  to  hasten  the  absorption 
of  the  poison.  Internally  administered,  olive  oil  is  not  only  demulcent, 
but  possesses  marked  nutritive  and  laxative  properties.  It  is  often 
taken  in  wines  and  liquors  for  its  nutritive  value. 

LINUM—  U.   S.  P. 

(Linseed;  Flaxseed.) 

Linseed  is  the  ground  seed  of  Linum  usitatissimum,  or  common 
flax,  which  is  cultivated  in  all  temperate  countries.  Its  chief  ingredi- 
ents are  a  fixed  oil  and  a  mucilaginous  principle.  The  oil  (Oleum 
Lini,  U.  S.  P.)  is  official,  and  enters  as  an  essential  constituent  into  the 
following  preparations: 

Linimentum  Calcis,  U.  S.  P. 
Sapo  Mollis,  U.  S.  P.  (Soft  Soap). 
Linimentum  Saponis  Mollis,  U.  S.  P. 
Liquor  Cresolis  Compositus,  U.  S.  P. 

Physiologic  Action  and  Therapeutics. — An  infusion  or  tea  of 
faxseed  makes  an  excellent  demulcent  drink.  The  ground  flaxseed  is 
probably  used  for  the  ordinary  poultice  in  deep-seated  inflammations 
more  than  any  other  substance.  The  oil  is  similar  to  olive  oil  in  its 
action  and  uses.     Mixed  with  an  equal  quantity  of  lime-water,  it  makes 


112  EMOLLIENTS,    DEMULCENTS,    AND    PROTECTIVES. 

the  official  linimentum  calcis,  commonly  called  carron  oil,  an  ex- 
cellent remedy  for  the  treatment  of  burns.  The  liniment  of  soft 
soap,  called  tincture  of  green  soap,  should  be  in  every  dental  office,  and 
used  frequently  on  the  hands  for  detergent  purposes. 

ADEPS  LANiE— U.  S.  P. 
(Lanolin;  Wool-fat.) 

Lanolin,  or  wool-fat,  is  the  purified  fat  of  the  wool  of  sheep,  freed 
from  water.  It  is  a  yellowish-white,  unctuous  substance,  having  a. 
faint  peculiar  odor.  The  Pharmacopeia  also  recognized  a  wool-fat 
which  contains  about  30  per  cent,  of  water  (Adeps  Lanae  Hydrosus,. 
U.  S.  P.) 

Therapeutics. — Lanolin  is  extensively  used  as  a  vehicle  for  oint- 
ments. It  is  bland  and  unirritating,  does  not  become  rancid,  and  has 
the  distinct  advantage  of  being  miscible  with  twice  its  weight  of  water 
without  losing  its  ointment-like  character.  With  this  vehicle,  there- 
fore, aqueous  substances  may  be  made  into  ointments.  It  is  used  as 
the  vehicle  for  devitalizing  pastes  for  the  dental  pulp.  The  hydrous, 
wool-fat,  in  pharmacy,  is  used  as  a  constituent  in  many  of  the  official 
ointments. 

PETROLATUM— U.  S.  P. 

(Vaselin;  Cosmolin.) 

Petrolatum  is  a  mixture  of  hydrocarbons,  chiefly  of  the  methane 
series,  obtained  by  distilling  off  the  more  volatile  portions  of  petroleum 
and  purifying  the  residue.  The  melting-point  should  be  between  450 
and  480  C.  Three  forms  are  official:  Petrolatum,  U.  S.  P.  (ordinary 
petrolatum),  a  yellowish,  ointment-like  mass;  Petrolatum  Album, 
U.  S.  P.  (white  petrolatum),  a  white  ointment-like  mass,  and  Petrolatum 
Liquidum,  U.  S.  P.  (liquid  petroleum),  a  clear,  colorless,  oily  liquid. 

Therapeutics. — Petrolatum  is  bland  and  unirritating,  and  is 
extensively  used  as  an  emollient  and  protective  dressing.  It  is  largely 
substitued  for  benzolated  lard  in  ointments.  Phenolized  vaselin 
(3  per  cent,  phenol)  is  a  household  remedy  for  burns,  bruises,  and  other 
excoriations.  An  ointment  made  from  orthoform  (40  parts)  and 
europhen  (60  parts),  with  liquid  vaselin  as  the  vehicle,  is  a  specific  for 
pain  following  the  extraction  of  teeth  where  the  alveolar  process  has 
been  exposed;  it  acts  here  also  as  an  emollient  and  protective.  Liquid 
vaselin  containing  2  per  cent,  of  menthol  is  an  excellent  emollient 
to  be  used  as  a  spray  in  acute  coryza. 


l'\K\lll\l   M—  ACACIA — TRAGACAM  IIA.  II3 

PARAFFINUM— U.   S.  P. 

(Paraffin.) 

Paraffin  should  be  discussed  in  connection  with  petrolatum. 
It  is  a  mixture  of  solid  hydrocarbons  obtained  from  the  same  source. 
It  is  a  white  solid,  and  should  melt  between  51. 6°  and  57. 20  C. 

Therapeutics. — Gersung,  in  1900,  recommended  the  subcutane- 
ous and  submucous  injections  of  paraffin  for  the  correction  of  various 
defects  and  for  cosmetic  purposes.  Beck,  of  Chicago,  has  employed 
the  method  quite  extensively  for  the  correction  of  nasal  deformities; 
and  paraffin  has  also  been  injected  about  the  jaws  with  excellent 
results  in  cases  of  necrosis  and  other  diseases  where  bone  tissue  has 
been  lost  or  removed.  The  paraffin  should  be  sterilized  by  boiling  and 
must  be  injected  with  a  specially  prepared  syringe  while  warm  and 
semisolid.  This  substance  when  so  injected  is  "not  absorbed,  but 
finally  becomes  encapsulated.  Paraffin  has  also  been  used  for  filling 
root-canals. 

ACACIA— U.  S.  P. 
(Gum  Arabic.) 

Acacia  is  a  gummy  exudation  obtained  from  Acacia  Senegal,  and 
other  species  of  Acacia,  a  small  tree,  deeply  and  firmly  rooted,  growing 
in  India,  Africa,  and  other  countries.  It  is  soluble  in  water.  The 
following  preparations  are  official : 

Mucilago  Acaciae,  U.  S.  P.     Dose,  freely. 
Syrupus  Acaciae,  U.  S.  P.     Dose,  freely. 

Therapeutics. — Acacia  is  used  in  therapeutics  chiefly  for  its 
demulcent  property.  The  mucilage  may  be  further  diluted  with  water 
and  administered  freely  in  cases  of  poisoning  from  corrosive  drugs. 
In  pharmacy  it  is  the  emulsifying  agent  generally  employed  in  making 
emulsions  of  oleaginous  drugs;  it  is  also  used  in  pills  and  lozenges 
for  holding  together  the  active  ingredients. 

Incompatibles. — It  is  incompatible  with  alcohol,  ferric  salts,  and 
borax. 

TRAGACANTHA— U.  S.  P. 

(Tragacanth.) 

Tragacanth  is  a  gummy  exudation  obtained  from  Astragalus 
gummifer.  a  small  shrub  growing  in  western  Asia.     This  gum  differs 


114  EMOLLIENTS,    DEMULCENTS,    AND    PROTECTIVES. 

from  acacia  in  that  it  does  not  dissolve  in  water,  but  swells  up  in  it  and 
forms  a  gelatinous  mass.     The  official  preparation  is: 

Mucilago  Tragacanthae,  U.  S.  P. 

Therapeutics. — Though  possessing  demulcent  properties,  it  is 
impracticable  to  use  it  as  such  on  account  of  its  insolubility.  The 
mucilage  of  tragacanth  may  be  used  as  an  emollient  in  chapped  hands 
and  other  skin  lesions.  In  pharmacy  it  is  used  for  suspending  resin- 
ous and  oleaginous  drugs  in  water;  it  also  enters  into  the  official 
emulsion  of  chloroform  and  into  most  of  the  official  troches. 


GLYCYRRHIZA— U.   S.  P. 

(Licorice  Root.) 

Glycyrrhiza  in  the  root  of  Glycyrrhiza  glabra,  or  Glycyrrhiza 
glandulifera,  a  perennial  herb  growing  in  the  countries  lying  on  the 
northern  and  southern  shores  of  the  Mediterranean  Sea;  also  cultivated 
in  England  and  the  United  States.  It  contains  a  glucosid,  glycyrrhizin, 
to  which  is  due  its  sweetish  taste;  it  also  contains  an  acrid  resin,  starch 
and  gum.     The  following  preparations  of  licorice  are  official: 

Fluidextractum    Glycyrrhizae,    U.    S.    P.     Dose,    15-60    min. 

(1 .0-4.0  c.c.). 

Extractum  Glycyrrhizae,  U.  S.  P.     Dose,  freely. 

Extractum  Glycyrrhizae  Purum,  U.  S.  P.     Dose,  freely. 

Mistura  Glycyrrhizae  Composita,  U.   S.  P.     Dose,   1-4  fl.   dr 

(4.0-16.0  c.c). 

Pulvis    Glycyrrhizae    Compositus,    U.    S.    P.     Dose,    1/2-2  dr. 

(2.0-8.0  gm.). 

Trochisci  Glycyrrhizae  et  Opii,  U.  S.  P.  (each  contains  1  /12  gr. 

— 0.005  BP**  —Powdered  Opium). 

Glycyrrhizinum  Ammoniatum,  U.  S.  P. 

Physiologic  Action  and  Therapeutics. — Licorice  root  is  demul- 
cent and  slightly  laxative,  and  when  chewed  increases  the  flow  of  saliva. 
It  slightly  stimulates  and  favors  the  secretion  of  mucus  in  the  res- 
piratory passages.  It  is  a  popular  remedy  for  cough,  sore  throat,  and 
hoarseness.  It  is  found  in  many  of  the  pharmaceutic  preparations, 
and  may  be  used  to  advantage  in  masking  the  taste  of  nauseating 
drugs.  The  official  fluid  extract  and  extract,  and  the  syrup  (N.  F.) 
are  largely  used  for  this  latter  purpose. 


ALTHAEA — SASSAFRAS    MEDULLA — ULMUS.  115 

ALTHAEA— U.  S.  P. 

(Marshmallow.) 

Marshmallow  is  the  dried  root  of  Althcea  officinalis,  a  perennial 
herb  growing  "in  most  countries  with  a  temperate  climate.  Its  chief 
constituents  are  mucilage,  sugar,  and  starch. 

Physiologic  Action  and  Therapeutics. — Marshmallow  is 
emollient,  demulcent,  and  protective,  and  may  be  employed  as  such  in 
all  irritable  and  inflamed  conditions  of  the  mucous  membrane  and  skin. 

SASSAFRAS  MEDULLA— U.  S.  P. 

(Sassafras  Pith.) 

Official  sassafras  is  the  dried  pith  obtained  from  the  branches  of 
Sassafras  variifoUum,  a  tree  indigenous  to  North  America.  The 
official  preparation  is: 

Mucilago  Sassafras  Medullae,  U.  S.  P. 

Physiologic  Action  and  Therapeutics. — Mucilage  of  sassafras 
pith  is  a  pleasant  demulcent,  and  may  be  used  wherever  such  is  indi- 
cated. An  infusion  or  tea  made  from  the  bark  of  the  root  of  the 
sassafras  tree  has  long  been  a  domestic  remedy  as  a  "spring  tonic." 

ULMUS— U.  S.  P. 

(Slippery  Elm.) 

Slippery  elm  is  the  dried  inner  bark  of  Ulmus  fulva,  a  large  tree 
growing  in  the  United  States  and  Canada.     It  contains  much  mucilag- 
inous matter.     The  official  preparation  is: 
Mucilago  Ulmi,  U.  S.  P.     Dose,  freely. 

Physiologic  Action  and  Therapeutics. — The  mucilage  of  elm 
is  a  decided  demulcent,  and  is  supposed  to  possess  nutritive  properties. 
It  is  pleasant  to  the  taste,  and  generally  does  not  disturb  the  stomach. 
It  is  especially  useful  after  washing  out  the  stomach  for  any  purpose 
In  the  form  of  troches  (elm  lozenges),  it  is  useful  as  a  soothing  agent 
in  irritated  or  sore  throat 

COLLODIUM— U.  S.  P. 

(Collodion.) 

Collodion  is  a  solution  of  pyroxylin,  or  gun  cotton,  4,  in  ether  75, 
and  alcohol  25  parts.     It  is  a  colorless,  syrupy  liquid,  highly  inflamma- 


Il6  EMOLLIENTS,    DEMULCENTS,    AND    PROTECTIVES. 

ble,  and  having  a  strong  ethereal  odor.     The  following  preparations 
are  official: 

Collodium  Flexile,  U.  S.  P. 

Collodium  Stypticum,  U.  S.  P.  (Tannic  Acid,  20  per  cent.). 
Collodium    Cantharidatum,    U.    S.    P.    (Blistering    Collodion; 
Cantharides,  60  per  cent.). 

Therapeutics. — When  applied  to  the  skin,  collodion  quickly  dries 
and  forms  a  thin  film,  which  not  only  protects  an  exposed  part,  but 
produces  slight  compression.  It  therefore  makes  an  excellent  pro- 
tective for  aseptic  wounds,  fissures,  and  punctures.  This  agent  affords 
an  efficient  means  of  securing  neat  antiseptic  dressings  on  dentist's 
hands  which  may  be  abraded  or  punctured  by  instruments.  The 
wound,  if  necessary,  can  be  cauterized  with  phenol  or  silver  nitrate, 
and  then  covered  with  an  antiseptic  powder  like  europhen  or  boric 
acid;  this  should  be  covered  with  absorbent  cotton  and  the  dressing 
retained  with  collodion.  Thus  treated,  the  wound  is  well  protected 
and  should  heal  by  first  intention.  The  flexible  collodion  cracks 
less  readily  than  the  plain  collodion,  and  may  be  used  if  desired. 

Styptic  collodion  applied  to  small  wounds,  like  cold-sores  on  the 
lip,  will  check  capillary  oozing.  Cantharidal  or  blistering  collodion 
may  be  used  as  a  counterirritant  in  pericemental  inflammations,  and 
neuralgias. 

Gutta-perchae,  (unofficial). — Gutta-percha  is  a  milky,  concrete 
exudation,  occurring  in  several  species  of  the  gutta  tree,  which  is  indig- 
enous to  the  Malay  Archipelago,  Sulu  Islands,  Java,  and  recently  it 
was  learned  that  the  gutta  trees  grow  abundantly  in  the  Philippine 
Islands.  When  pure,  gutta-percha  has  a  specific  coloring  between 
pink  and  grayish-white.  Single  pieces  are  not  adhesive  at  ordinary 
temperatures,  but  heated  slightly  and  pressed  together  the  pieces 
adhere  and  cannot  be  separated.  Gutta-percha  is  insoluble  in  water 
and  alcohol,  but  soluble  in  chloroform,  eucalyptol,  and  cineol. 

Therapeutics. — Gutta-percha  dissolved  in  chloroform  may  be 
used  as  a  protective  for  small  wounds.  It  has  also  been  employed  as  a 
means  of  retaining  antiseptic  and  other  dressings  in  the  canals  of  teeth. 
For  this  purpose  it  does  not  exclude  the  bacteria-laden  saliva,  and 
should  be  discarded.  The  solution,  known  as  chloropercha,  has  long 
been  successfully  used  in  moistening  the  dried  canal  previous  to  filling 
with  a  gutta-percha  cone.  The  author  suggests  heating  the  white 
base-plate  gutta-percha  in  eucalyptol  compound  (see  p.  295),  when  a 
thick,  creamy  solution  results,  which  becomes  a  soft  solid  when  cold. 
This  preparation  is  used  in  filling  root-canals,  as  will  be  explained  in 


TALCUM — KAOLIN  UM.  117 

Practical  Therapeutics.  Cochran  suggests  making  a  saturated  solution 
of  thymol  in  cucalyptol,  and  after  cutting  the  gutta  pcrcha  with 
chloroform  mixing  the  two  solutions,  permitting  the  chloroform  to 
evaporate  when  a  soft  solid  results,  which  is  used  in  filling  root-canals. 

TALCUM— U.  S.  P. 

(Talc;  Magnesium  Silicate;  Soapstone.) 

Talc  is  a  native  hydrous  magnesium  silicate,  and  occurs  in  grayish- 
green  masses  with  a  waxy  luster,  or  as  a  white  or  pale  gray  powder. 
It  feels  greasy  to  the  touch,  hence  it  is  commonly  called  soapstone. 
The  Pharmacopeia  also  recognizes  a  purified  talc  (Talcum  Purincatum, 
U.  S.  P.),  which  is  used  in  the  preparation  of  essential  oil  waters. 

Therapeutics.— Finely  powdered  talc  is  employed  as  a  dusting 
powder  in  inflammatory  diseases  of  the  skin,  such  as  acute  erythema- 
tous eczema.  A  useful  formula  is:  Pulverized  talc,  4  dr.  (16.0  gm.); 
zinc  oxid,  3  dr.  (12.0  gm.);  boric  acid,  1  dr.  (4.0  gm.).  This  powder  is 
also  useful  in  chafing.  Many  of  the  commercial  talcum  powders  con- 
tain talc  and  boric  acid  in  varying  proportions.  Talc,  or  soapstone,  is 
used  in  dentistry  also  to  coat  the  model  so  that  it  will  draw  nicely  from 
the  moulding  sand  in  making  a  metal  die. 

KAOLINUM— U.  S.  P. 

(Fuller's  Earth;  Hydrated  Aluminum  Silicate.) 

Kaolin  is  a  native  aluminum  silicate,  occurring  as  a  soft,  white, 
or  yellowish-white  powder,  odorless,  and  having  an  earthy  or  clay-like 
taste.  It  is  insoluble  in  water,  but  becomes  unctuous  when  moist.  It 
is  a  very  pure  clay,  having  the  chemic  formula,  H2Al2Si208.H20. 
The  official  preparation  is: 

Cataplasma  Kaolini,  U.  S.  P. 

Therapeutics. — The  cataplasm  is  used  as  a  poultice,  applied  hot, 
in  mild  local  infections  about  the  face  and  jaws.  Kaolin  is  also  used  in 
dusting  powders,  and  is  a  constituent  of  porcelain  body.  In  pharmacy 
it  is  used  in  pills  containing  easily  reduced  drugs,  like  silver  nitrate  and 
potassium  permanganate,  which  cannot  be  mixed  with  the  ordinary  pill 
excipients. 

LYCOPODIUM— U.  S.  P. 
Lycopodium  is   the  spores  of  Lycopodium   clavatum   and  other 
species  of  Lycopodium,  mosses  growing  in  nearly  all  temperate  coun- 
tries.    It  is  a  fine  powder,  pale  yellow  in  color,  very  mobile,  inodorous, 


Il8  LOCAL   ANESTHETICS. 

tasteless,  floats  upon  water  and  not  wetted  by  it,  and  burns  quickly 
when  thrown  into  a  flame. 

Therapeutics. — Lycopodium  is  employed  in  therapeutics  as 
a  protective.  It  possesses  great  absorbent  power  for  oils,  which,  to- 
gether with  its  dryness  and  lightness,  renders  it  an  excellent  dusting- 
powder  for  superficial  ulcers,  eczema,  etc.  In  dentistry  it  is  also  used, 
like  soapstone,  for  coating  models  in  making  dies;  and  in  pharmacy 
it  is  employed  to  prevent  the  adhesion  of  newly-made  pills  and 
suppositories. 

In  the  discussion  of  drugs  thus  far,  the  author  has  endeav- 
ored to  group  them,  as  far  as  was  possible,  into  local  and  general 
remedies.  Those  having  been  considered  are  employed  largely  in 
therapeutics  for  their  local  effects  upon  the  skin  and  mucous  membranes 
of  the  respiratory  and  alimentary  passages.  The  consideration  of  the 
next  group,  local  anesthetics,  will  naturally  lead  us  into  the  discussion 
of  general  anesthetics,  and  from  then  on  general  remedies  will  be 
considered. 

ANESTHETICS. 

Anesthetics  have  been  elsewhere  defined  as  agents  which  tempora- 
rily destroy  sensation.  They  are  subdivided  into  two  classes:  i.  Those 
which  produce  local  anesthesia;  and  2.  those  which  produce  general 
anesthesia.  By  local  anesthesia  is  meant  the  abolition  of  sensibility  to 
pain  in  a  part;  general  anesthesia  means  the  abolition  of  all  sensibility, 
including  unconsciousness.  In  the  administration  of  general  anes- 
thetics, the  patient  experiences  a  stage  where  they  are  insensible  to  pain, 
though  not  unconscious.  This  condition  is  known  as  analgesia, 
which  means  the  absence  of  sensibility  to  pain.  Agents  which  pro- 
duce the  condition,  whether  general  anesthetics,  like  nitrous  oxid, 
chloroform  or  ether,  or  other  drugs,  such  as  opium,  the  coal-tar  deriva- 
tives— antipyrin,  acetanilid,  and  phenacetin — the  bromids,  chloral,  etc., 
are  called  analgesics.  Closely  associated  with  these  drugs  is  the  term 
anodyne,  which  means  an  agent  that  relieves  pain.  An  anodyne  effect 
presupposes  the  presence  of  pain,  an  analgesic  effect  does  not;  it 
simply  means  that  pain  cannot  be  experienced.  Many  drugs  possess 
local  anodyne  properties,  such  as  many  volatile  oils,  phenol,  cresol,  etc. 

LOCAL  ANESTHETICS. 

Local  anesthetic  agents  may  be  conveniently  subdivided  into  two 
classes,  according  to  their  mode  of  action  by  which  the  anesthetic  effect 
of  the  drug  is  produced. 


iETHYLIS    CHLORIDUM.  Iig 

i.  Refrigerant. — Those  agents  which  produce  a  degree  of  cold 
by  the  abstraction  of  heat  from  the  part  to  which  they  are  applied, 
even  to  the  point  of  freezing  the  tissue. 

2.  Paralyzant. — Those  agents  when  applied  locally  have  a 
direct  paralyzant  action  upon  the  sensory  nerve  terminals. 

Refrigerant.  Paralyzant. 

Ethyl  Chlorid  Spray  Cocain. 

Ether  Spray.  Tropacocain. 

Rhigolene  Spray.  Eucain. 

Ice.  Novocain. 

Chloretone. 

Orthoform. 

jETHYLIS  CHLORIDUM— U.  S.  P. 

(Ethyl  Chlorid;  Kelene;   C2HSC1.) 

Ethyl  chlorid  is  prepared  by  the  action  of  hydrochloric  acid  gas 
upon  absolute  ethyl  alcohol,  the  hydroxyl  radical  in  the  latter  being 
replaced  by  chlorin.  It  occurs  as  a  colorless,  extremely  volatile  liquid, 
having  an  odor  resembling  that  of  chloroform  and  a  burning  taste. 
The  vapor  is  highly  inflammable,  and  it  should  not  be  used  near  a  gas- 
flame  or  burning  alcohol-la  nip. 

Physiologic  Action. — Applied  locally  by  means  of  a  spray, 
ethyl  chlorid  acts  as  a  refrigerant  local  anesthetic,  the  tissues  soon  be- 
coming white  and  superficially  frozen  from  the  abstraction  of  heat. 

The  drug  may  be  inhaled  from  gauze  or  a  specially  devised  in- 
haler which  is  adjusted  to  the  face,  when  it  acts  as  a  general  anesthetic. 
The  anesthesia  is  usually  accompanied  by  a  fall  of  arterial  pressure 
and  a  gradual  decrease  in  the  pulse-rate,  due  in  all  probability  to  a 
direct  action  upon  the  heart.  The  patient  becomes  anesthetized,  as  a 
rule,  in  from  1  to  3  minutes,  and  from  1-2  fl:  dr.  (4.0-8.0  c.c.)  of  the 
drug  being  required,  depending  upon  the  patient.  Its  action  is  rapid 
and  unirritating  to  the  mucous  membrane  of  the  respiratory  passages; 
there  is  an  absence  of  choking  sensation  or  cyanosis;  and  but  rarely 
does  nausea  or  vomiting  follow.  The  recovery  is  generally  complete  in 
from  2  to  5  minutes. 

Therapeutics. — Ethyl  chlorid  is  usually  sold  in  small  metallic 
or  glass  tubes,  provided  with  a  lever-spring  or  screw  top.  When  the 
lever  is  depressed  or  the  screw  released,  the  liquid  is  expelled  as  a  spray 
by  the  heat  of  the  hand.  This  drug  is  a  safe  and  convenient  local 
anesthetic  for  minor  operations  requiring  but  a  single  incision,  as  in  the 
lancing  of  abscesses,  boils,  etc.,  or  for  the  extraction  of  loose  teeth.     Its 


120  LOCAL    ANESTHETICS. 

local  anesthetic  action  is  not  sufficiently  profound  to  permit  the  painless 
extraction  of  firmly  attached  teeth.  There  is  very  little  danger  attend- 
ing the  local  use  of  the  drug  from  inhalation. 

The  drug  may  be  used  as  a  general  anesthetic  for  minor  surgical 
operations  necessitating  the  administration  of  a  general  anesthetic. 
Ethyl  chlorid  is  a  constituent  of  many  commercial  products  sold  for 
general  anesthetic  purposes,  among  which  may  be  mentioned  somno- 
Jorm,  narcotile,  etc. 

As  a  general  anesthetic,  ethyl  chlorid  has  the  one  advantage  over 
nitrous  oxid,  or  nitrous  oxid  and  oxygen,  in  not  requiring  the  cumber- 
some apparatus  for  its  administration,  but  its  safety  as  such  cannot  be 
compared  with  nitrous  oxid.  Though  the  drug  has  only  been  used  a 
few  years  as  a  general  anesthetic,  quite  a  number  of  deaths  from  its  use 
have  been  reported. 

Ether  Spray. — Ether,  or  ether  and  alcohol,  in  the  form  of  a 
spray  has  been  suggested  as  a  means  of  desensitizing  dentin.  It  acts 
as  a  refrigerant  local  anesthetic. 

Rhigolene  Spray. — Rhigolene  is  an  unofficial  distillate  of 
petroleum.  It  may  be  used  as  a  spray  for  the  same  purpose  as  ether, 
but  has  no  advantages  over  the  latter. 

Ice. — Ice,  or  the  ice  and  salt  mixture,  was  probably  the  first  of 
all  local  anesthetics.  Though  its  use  is  largely  superseded,  especially 
in  the  mouth,  by  the  volatile  liquids,  like  ether  and  ethyl  chlorid,  it 
still  has  a  place  of  usefulness  upon  accessible  surfaces. 

An  ice-poultice  may  be  made  by  sewing  up  tightly  in  rubber 
cloth  crushed  ice  mixed  with  salt,  and  sawdust,  bran,  or  ground  flax- 
seed. Local  applications  of  cold  in  this  manner  abstract  heat  from 
the  part,  lessen  the  sensibility  of  the  peripheral  nerve-filaments,  cause 
constriction  of  the  blood-vessels  traversing  the  tissues  exposed  to  the 
cold,  and  by  reflex  action  affect  the  vascularity  of  the  parts  subjacent 
to  the  site  of  application. 

COCA— U.   S.  P. 

Coca  is  the  dried  leaves  of  Erythroxylon  coca,  a  plant  grow- 
ing in  the  mountainous  regions  of  Peru,  Bolivia,  and  other  South 
American  states.  It  contains  a  number  of  alkaloids,  the  most  impor- 
tant being  cocain,  which  is  official  both  as  the  alkaloid  and  alkaloidal 
salt  under  the  titles,  respectively,  Cocaina  and  Cocaince  Hydro- 
chloridum. 

The  general  rule  adopted  by  the  United  States  Pharmacopeia  in 
the  nomenclature  of  articles  of  botanical  origin  is  for  the  Latin  title 


COCAINA — COCAIN/E    IIYDROCHLORIDUM.  121 

to  be  the  genus  name  of  the  plant  and  not  the  species.  ( 'oca,  how  ever, 
is  a  notable  exception  to  this  rule;  for  instead  of  calling  this  article 
Erythroxylon,  it  is  officially  designated  Coca.  While  the  early  generic 
names  of  plants  were  selected  rather  arbitrarily,  the  differentiation 
of  their  species  is  almost  invariably  indicated  in  their  specific  names; 
yet  some  of  the  native  plant  names  lead  to  great  confusion.  Students 
frequently  confuse  the  names  cocoa  (cacao),  coco  (nut),  and  coca, 
three  separate  and  distinct  plants.  When  Von  Humboldt  discovered 
the  chocolate  nut  he  named  it  Theobroma  (meaning  God's  drink) 
and  cacao,  after  the  native  Indian  name;  but  it  has  always  been  con- 
fused, because  of  the  similarity  of  names,  with  the  Cocos  nucifera, 
the  milk-bearing  cocoanut;  and  by  many  to-day  the  oil  of  theobroma 
is  called  cocoa-butter  instead  of  cacao.  It  should  be  remembered 
that  coca  is  the  official  name  for  the  plant,  from  the  leaves  of  which 
that  valuable  alkaloid,  cocain  is  obtained.  The  following  prepa- 
rations of  coca  are  official: 

Fluidextractum  Cocae,  U.  S.  P.     Dose,  1-2  fl.  dr.  (4.0-8.0  c.c). 
Vinum  Cocae,  U.  S.  P.     Dose,  2-4  fl.  dr.  (8.0-15.0  c.c). 

COCAINA— U.  S.  P. 
(Cocain;  C8HI3(C6HsCO)NO.COOCH3.) 

Cocain  occurs  in  the  form  of  colorless,  prismatic  crystals, 
having  the  bitter  taste  characteristic  of  all  alkaloids,  and  producing 
on  the  tongue  a  temporary  numbness.  It  is  sparingly  soluble  in 
water  (1-600  parts),  much  more  so  in  alcohol  (1-5  parts),  more  readily 
in  both  when  warm,  in  ether  (1-38),  and  in  the  oils  (about  1-12). 
The  average  dose  is  about  1/2  gr.  (0.030  gm.).  There  is  one  new- 
official  preparation: 

Oleatum  Cocairue,  U.  S.  P.  (contains  5  per  cent,  of  the  alkaloid). 

COCAINE  hydrochloridum— u.  s.  p. 

(Cocain  Hydrochlorid;  CI7  H21  N04C1.) 

Cocain  hydrochlorid,  called  previous  to  the  U.  S.  P.  of  1900 
cocain  hydrochlorate,  occurs  in  the  form  of  colorless  prisms,  lustrous 
leaflets  or  flakes,  or  crystalline  powder.  This  alkaloidal  salt,  like  the 
alkaloid  itself,  has  a  bitter  taste,  and  leaves  a  temporary  numbness 
on  the  tongue.  It  is  freely  soluble  in  water  (1-0.4  part),  somewhat 
less  so  in  alcohol  (1-2.6  parts),  and  insoluble  in  ether  and  oils. 

The  amount  to  be  injected  hypodermically  at  one  time  should 
not  exceed  1/4  to  1/2  gr.  (0.016-0.03  gm0- 


122  LOCAL   ANESTHETICS. 

Brief  History. — It  may  be  stated  as  a  matter  of  history  that  the 
introduction  of  cocain  to  the  medical  and  dental  world  was  due  to 
Roller,  of  Vienna,  who,  in  1884,  reported  his  experiments  with  the 
drug  to  the  Congress  of  German  Oculists.  In  a  few  weeks  cocain 
or  the  alkaloidal  salt,  cocain  hydrochlorid,  was  being  used  as  a  local 
anesthetic  all  over  the  world.  Among  the  men  whose  names  should  be 
mentioned  as  early  investigators  are  the  following:  Hepburn,  Biggs,Hall, 
Halsted,  Rudolph  Metas,  J.  L.  Corning,  C.  P.  Pruyn,  and  others.  Hall, 
in  1884,  demonstrated  by  an  experiment  upon  himself  that  he  could 
inject  solutions  of  cocain  hydrochlorid  into  the  infraorbital  nerve  and 
anesthetize  the  teeth.  Halsted,  in  the  following  year,  1885,  and  some 
gentlemen  in  South  America  about  the  same  time,  not  knowing  that 
Halsted  was  working  along  the  same  line,  demonstrated  that  they  could 
inject  9  minims  of  a  4  per  cent,  solution  into  the  inferior  dental 
nerve  as  it  entered  the  inferior  dental  canal,  and  produce  complete 
anesthesia  of  the  gums  and  teeth  on  that  side  of  the  jaw.  It  was  about 
this  time  that  Pruyn,  of  Chicago,  conducted  a  long  series  of  experi- 
ments on  dogs,  and  to  him  much  credit  is  due  for  the  high  place  which 
cocain  occupies  in  dental  practice  to-day.  In  speaking  of  these  experi- 
ments, Pruyn1  says:  "The  first  dog  that  I  experimented  on,  and  sub- 
sequently killed,  made  me  shudder  to  see  the  poor  animal  in  the  throes 
of  death  fighting  for  his  breath.  It  made  an  impression  on  me  that  has 
lasted  ever  since,  and  taught  me  that  cocain  should  be  handled  very 
carefully,  particulary  when  we  are  using  it  upon  the  human  subject." 
Therefore,  the  alarming  symptoms  and  the  frequent  fatalities  which 
followed  the  early  use  of  cocain  caused  it  for  a  time  to  be  barred 
from  general  use  in  general  and  dental  surgery.  The  fact,  however, 
that  many  patients  objected  to  general  anesthetics  on  account  of  the 
unconsciousness  induced,  and  the  further  fact  that  every  conscientious 
surgeon  recognized  that  a  certain  amount  of  danger  always  attends 
the  administration  of  general  anesthetics  were  sufficient  to  cause  a 
few  men  to  further  experiment  with  the  drug.  They  diminished  the 
strength  of  the  solution,  and  gradually  mastered  the  technic  of  its  ad- 
ministration until  the  alarming  symptoms  and  frequent  fatalities  were 
largely  overcome.  So  cocain  stands  to-day  with  scarcely  a  rival  as  a 
local  anesthetic,  notwithstanding  the  many  attempts  to  displace  the 
drug  by  the  products  of  manufacturing  chemists. 

Physiologic  Action. — -Whatever  effects  result  from  the  admin- 
istration of  preparations  of  coca  are  due  entirely  to  the  alkaloids  con- 
tained therein.     Cocain  is  a  typical  local  anesthetic  of  the  paralyzant 

1  Dental  Review,  Vol.  16,  p.  312 


COCAINA — COCAINiE    HYDROCHLORIDUM.  1 23 

group.  When  the  drug  enters  the  circulation  its  first  action  is  that  of  a 
stimulant,  followed  shortly  by  a  depressant  effect.  It  is  a  general  pro- 
toplasmic poison,  and  acts  deleteriously  upon  all  kinds  of  tissue.  It 
has  been  supposed  that  the  drug  acts  more  prominently  upon  nerve 
tissue,  but  such  is  not  the  case.  It  is  true  that  its  action  is  more  dis- 
cernible upon  nerve  tissue  for  the  reason  that  this  tissue  is  the  me- 
dium of  sensation  and  expression.  When  applied  locally  or  injected 
beneath  the  mucous  membrane  or  skin,  its  depressant  action  on 
the  sensory  nerve  filaments  is  sufficiently  profound  to  induce 
complete  local  anesthesia  or  analgesia.  It  is  also  a  powerful  vaso- 
constrictor; the  ischemia  produced,  however,  is  ultimately  followed 
by  congestion. 

Long  before  the  drug  was  used  as  a  medicine,  the  natives  of 
South  America  learned  that  by  eating  the  leaves  of  the  coca  plant  they 
could  travel  for  days  through  the  deserts  without  experiencing  the 
sensation  of  hunger.  We  now  know  that  the  cocain  paralyzed  the 
nerve  filaments  which  control  the  appetite. 

Poisoning  and  Treatment. — The  symptoms  of  acute  cocain 
poisoning  are  rather  variable.  The  usual  train  of  symptoms  are  nervous 
excitement,  followed  by  delirium,  and  later  by  drowsiness  and  stupor; 
nausea,  vomiting,  a  rapid  pulse,  hurried  and  difficult  respiration,  dila- 
tation of  the  pupils,  cold  sweat,  blanched  expression,  blue  lips,  convul- 
sive seizures,  and  finally  death  through  asphyxia. 

Individuals  differ  widely  in  their  susceptibility  to  cocain.  The 
local  application  of  even  moderate  solutions  of  the  drug  to  the  nose  or 
throat  in  some  subjects  is  followed  by  toxic  symptoms.  Some  have  a 
peculiar  idiosyncrasy  for  cocain.  Cases  have  been  authentically 
reported  where  the  drug  was  not  used,  but  where  the  patient  supposed 
it  had  been,  when  they  exhibited  the  usual  toxic  symptoms  in  mild  form. 

There  is  no  known  antidote  for  cocain;  therefore,  the  treatment  of 
poisoning  is  purely  symptomatic.  When  the  symptoms  are  rather 
mild  the  patient  should  be  kept  in  a  recumbent  position,  the  head 
lower  than  the  feet,  if  possible  (the  modern  dental  chair  makes  this 
possible),  and  such  stimulants  given  as  whisky,  brandy,  and  aromatic 
spirit  of  ammonia,  15-20  minims  (1. 0-1.3  c.c.)  of  the  latter  in  a  small 
quantity  of  water.  The  irritation  of  the  ammonia  is  what  is  desired, 
and  it  is  best  here  not  to  dilute  the  drug  too  much.  Spirit  of  ammonia 
or  spirit  of  camphor  may  be  given  by  inhalation.  Ammonia  irritates 
the  mucous  membrane,  and  thus  indirectly  stimulates  the  heart. 
When  the  symptoms  are  more  pronounced,  especially  when  the  patient 
is  unable  to  swallow  and  a  direct  cardiac  stimulant  is  required,  strych- 


124 


LOCAL    ANESTHETICS. 


nin  is  the  drug  to  administer.  This  may  be  given  hypodermically  in 
the  form  of  strychnin  sulphate,  the  injection  being  made  in  the  arm  or 
cellular  tissue  in  the  lumbar  region.  One-thirtieth  grain  (0.0025  gm.) 
may  be  administered  at  a  time  and  repeated  every  15  minutes,  if  occa- 
sion requires,  until  3  injections  are  made.     When  there  is  danger  of  res- 


FiG.  1. — Artificial  Respiration.     First  Movement. 

piratory  failure  atropin  sulphate  in  from  i/i20-i/6ogr.  (0.0005-0.001 
gm.)  should  be  given.  As  a  last  resort  to  prevent  asphyxia,  arti- 
ficial respiration  should  be  performed.  Sylvester's  method  is  the  one 
most  commonly  employed.  Figs.  1  and  2  show  the  position  of  patient 
and  attendant. 


FlG.  2. — Artificial  Respiration.     Second  Movement. 

With  the  patient  placed  on  his  back,  on  a  flat  surface,  supporting 
the  head  and  shoulders  with  a  cushion  or  articles  of  dress,  all  tight 
clothing  should  be  loosened  or  removed  from  the  neck  and  chest. 

The  movements  of  inspiration  and  expiration  should  regularly 
succeed  each  other  at  the  rate  of  from  20  to  25  respirations  per  minute,  or 


COCAINA — COCAINE    HYDROCHLORIIH'M.  1 25 

slightly  in  excess  of  the  normal  rate  (about  18  per  minute).  The  in- 
spiratory period  should  be  slightly  longer  than  the  expiratory.  In  all 
cases  the  artificial  respiration  should  continue  until  natural  respiration 
is  established.  This  may  require  hours,  and  necessitate  a  relay  of  as- 
sistants. In  the  treatment  of  poisoning  of  any  kind  the  operator 
should  avoid  the  appearance  of  excitement,  and  remember  that  as  long 
as  there  is  life  there  is  a  chance  of  recovery. 

Habit.— Cocain  is  one  of  the  most  seductive  of  the  drugs  that  are 
taken  habitually,  and  its  effects  are  most  disastrous.  A  potent  cause 
of  the  cocain  habit  has  been  the  frequent  use  of  the  drug  in  diseases  of 
the  nose  and  throat.  As  the  drug  is  used  in  dentistry  there  is  little 
chance  of  producing  the  habit;  yet  it  is  very  unwise  to  prescribe  the 
drug  to  be  used  by  the  patient  at  home  in  the  form  of  toothache  reme- 
dies, mouth-washes,  gargles,  or  nasal  sprays.  The  chief  symptoms  of 
the  cocain  habit  are  emotional  excitement,  physical  unrest,  mental  im- 
pairment, a  disregard  for  morals,  hallucinations,  gastric  disturbances, 
a  gradual  wasting  away,  and  anemia. 

Therapeutics. — There  is  a  demand  by  the  laity  for  painless 
dentistry,  and  no  one  drug  aids  the  dentist  more  in  meeting  this  de- 
mand than  cocain  or  its  alkaloidal  salt,  cocain  hydrochlorid.  The 
drug  is  extensively  used  in  the  painless  extraction  o]  teeth,  lancing  of 
abscesses,  the  removal  of  vital  dental  pirfps,  and  in  many  other  places. 
Cocain  hydrochlorid  is  recommended  in  cases  of  nausea  in  taking  im- 
pressions. Goslee  suggests  using  a  2  per  cent,  solution  in  an  atomizer, 
spraying  the  entire  palate  and  the  uvula.  A  glass  of  tepid  water 
should  be  at  hand  so  the  patient  may  rinse  the  mouth  after  a  few 
seconds,  to  avoid  swallowing  the  solution.  The  spraying  process  may 
be  repeated  about  every  five  minutes  until  two  or  three  applications 
have  been  made. 

Cocain  is  also  added  to  many  arsenical  preparations  to  control  the 
irritating  action  of  the  arsenic  trioxid.  If  the  vehicle  for  such  prepara- 
tions is  an  oil,  the  alkaloid  should. always  be  used,  as  the  alkaloidal  salt 
is  insoluble  in  oils. 

The  official  oleate  may  be  used  to  lessen  the  pain  in  setting  crowns 
and  bridges.  This  is  done  by  applying  the  remedy  under  the  margin 
of  the  gum  a  few  minutes  before  setting  the  crown.  Cocain  hydro- 
chlorid is  used  more  extensively  by  the  hypodermic  method  of  ad- 
ministration for  the  painless  extraction  of  teeth  than  for  any  other 
purpose  in  dentistry.  A  brief  discussion,  therefore,  of  the  hypodermic 
use  of  the  drug  will  here  be  considered. 

Sodium  chlorid  has  been  recommended  by  Schleich  and  others 


126  LOCAL   ANESTHETICS. 

as  an  excellent  agent  to  be  added  to  local  anesthetic  solutions  for  two 
reasons:  One  is  that  it  aids  in  the  elimination  of  the  drug,  and  the 
other,  and  more  important,  is  that  with  it  isotonic  solutions  can  be  pre- 
pared with  local  anesthetics  as  the  base.  The  action  of  the  so-called 
"salt  solutions"  will  be  discussed  under  Cathartics  (which  see,  p. 
204).  Transitory  anesthesia  can  be  produced  ultimately  by  pressure, 
or  by  simply  injecting  with  force  distilled  water  into  the  gum  tissue; 
but  distilled  water  being  hypoisotonic  to  the  normal  fluids  in  the  tissues, 
its  injection  causes  a  temporary  swelling  of  the  cells,  due  to  osmotic 
action,  and  primary  pain  is  produced.  On  the  other  hand,  the  injection 
of  a  hyperisotonic  solution  causes  a  temporary  condensation  of  the  cells, 
due  also  to  osmosis,  and  primary  pain  is  produced.  If,  therefore, 
isotonic  solutions  are  employed  for  the  purpose  of  inducing  local  an- 
esthesia, osmotic  action  is  avoided,  and  the  relation  of  the  cells  to 
each  other  is  not  materially  affected.  Prinz  suggests  adding  sodium 
chlorid  in  the  following  proportion  in  making  an  isotonic  solution  of 
cocain  hydrochlorid : 

Cocain  Hydrochlorid,  5  grs.  (0.3  gm.) 

Sodium  Chlorid,  4  grs.  (0.25  gm.) 

Distilled  Water,  1  fl.  oz.  (30.0  c.c.) 

To  each  syringeful  (30  min.-2.o  c.c.)  add  one  minim  (0.065  c-c0 
of  a  1-1000  solution  of  adrenalin  chlorid  when  used.  The  adrenalin 
solution  should  be  fresh.  The  technic  of  making  the  injection  has 
been  fully  discussed  under  the  Hypodermic  Method  (p.  22). 

The  principal  objections  to  the  use  of  cocain  hydrochlorid  as  a 
local  anesthetic  for  hypodermic  use  are  the  sloughing  of  tissue  so  often 
induced,  and  the  liability  to  poisoning.  These  are  important  consider- 
ations and  will  be  discussed  separately. 

1.  Sloughing. — -It  has  been  demonstrated  quite  conclusively  that 
the  aseptic  injection  of  sterile  isotonic  solutions  of  cocain  hydro- 
chlorid will  not  result  in  sloughing.-  Therefore,  sloughing  is  caused 
either  by  septic  infection  due  to  the  injection  or  to  the  irritation  pro- 
duced by  the  disturbed  relations  of  the  cells  from  the  injection  of 
solutions  which  are  not  isotonic  to  the  fluids  in  the  tissues.  It  must 
be  understood  here  that  the  latter  cause  mentioned  would  not  result 
in  sloughing  of  itself,  but  the  irritation  thus  produced,  together  with 
the  poisoning  of  the  protoplasm  of  the  cells  by  the  cocain,  so  lowers 
the  vital  resistance  of  the  affected  tissues  that  infection  is  more  liable 
to  follow  from  external  influences,  especially  where  there  has  been 
laceration  of  tissue,  as  in  extraction.     Sloughing,  therefore,  is  due  en- 


COCAINA — COCAINE    HYDROCHLORIDUM.  1 27 

tirely  to  septic  infection,  cither  from  the  injection  or  from  external 
influences.  How  to  guard  against  septic  infection  has  been  previously 
considered. 

2.  Poisoning. — Poisoning  by  cocain  hydrochlorid  is  due  either 
to  the  injection  of  an  overdose  or  to  idiosyncrasy.  As  has  been  else- 
where stated,  individuals  differ  widely  in  their  susceptibility  to  cocain. 
In  the  manner  of  its  action,  as  has  been  previously  stated,  cocain  is  a 
peculiar  drug.  Its  action  differs  with  different  individuals,  and  with 
the  same  individual  at  different  times.  There  is  no  way  of  fore- 
telling how  the  drug  is  going  to  affect  the  patient  in  a  given  case.  For 
this  reason  many  physicians  and  dentists  are  afraid  to  use  the  drug. 
However,  if  we  master  the  technic  of  its  administration  and  always 
know  the  quantity  injected,  there  is  no  necessity  for  fright,  even  though 
toxic  symptoms  develop,  providing,  of  course,  that  an  overdose  has 
not  been  injected.  It  is  practically  agreed  by  the  best  authorities  that 
the  maximum  quantity  of  cocain  hydrochlorid  to  be  permitted  to  enter 
the  circulation  at  one  time  should  not  exceed  one-quarter  of  a  grain 
(0.016  gm.). 

A  great  deal  of  the  ill-results  attributed  to  cocain  is  due  to  the 
carelessness  with  which  the  drug  is  used  or  to  shock  or  fright  on  the 
part  of  the  patient  for  which  the  drug  is  not  at  all  responsible.  Many 
times  patients  collapse  from  shock  or  faint  from  fear  or  dread  of  the 
operation;  and,  when  cocain  was  used  these  results  have  frequently 
been  attributed  to  the  drug,  when,  as  a  matter  of  fact,  the  same  result 
might  have  been  and  often  is  produced  when  no  anesthetic  had  been 
used.  Whenever  cocain  is  used  about  the  mouth  for  any  purpose  we 
should  always  have  the  patient  rinse  the  mouth  to  prevent  swallowing 
any  of  the  remedy,  for  the  smallest  quantity  of  cocain  in  the  stomach 
will  often  produce  nausea. 

Solutions  of  cocain  hydrochlorid  should  be  made  at  the  time 
from  soluble  hypodermic  tablets,  or  should  contain  antiseptics  to 
keep  the  solution  sterile.  Phenol  is  an  excellent  agent  to  add  for  this 
purpose,  and  in  from  1/2  to  1  per  cent,  it  has  no  perceptible  coagulant 
action  on  the  albumin  of  the  cells.  Two  per  cent,  of  boric  acid  may 
also  be  added.  The  author's  formula  for  hypodermic  injection, 
which  is  practically  isotonic,  follows: 

Cocain  Hydrochlorid,  5  gr.  (0.3  gm.) 

Sodium  Chlorid,  1  gr.  (0.06  gm.) 

Phenol  (95  per  cent.),  2  min.  (0.13  c.c.) 

Peppermint  Water,  1  fl.  oz.  (30  o  c.c.) 


128  LOCAL    ANESTHETICS. 

It  is  well  to  add  one  minim  (0.06  <  .c.)  of  a  fresh  1-1000  solution 
of  adrenalin  chlorid  to  30  minims  (2.0  c.c.)  of  the  solution  at  the  time 
of  injection.  It  should  be  remembered  that  about  23  minims 
(1.5  c.c.)  of  this  solution  contains  1/4  grain  (0.016  gm.)  of  the  alka- 
loidal  salt,  the  maximum  quantity  which  may  safely  enter  the  circula- 
tion at  one  time.  This  does  not  mean  that  only  23  minims  can  be 
used  at  one  injection;  for  a  certain  amount  is  lost  in  exhausting  the 
air  from  the  syringe,  and  a  certain  amount  actually  injected  is  re- 
moved before  it  enters  the  circulation,  due  to  the  subsequent  hemor- 
rhage. If  the  technic  of  injection  has  been  mastered,  one  barrelful  of 
the  syringe  should  be  amply  sufficient  to  painlessly  extract  all  of  the 
teeth  that  should  be  extracted  at  one  time,  when  any  local  anesthetic 
has  been  employed.  Cocain  should  never  be  used  without  having 
at  hand  in  a  convenient  and  practical  form  the  several  antidotes  for 
the  drug. 

There  are  many  proprietary  local  anesthetic  solutions  on  the 
market,  and  it  is  safe  to  say  that  cocain  enters  into  most  of  them  as  the 
base  of  the  formula.  In  this  day  of  advanced  dental  therapeutics  there 
is  no  necessity  or  excuse  for  using  any  proprietary  remedy,  the  composi- 
tion of  which  is  unknown,  especially  when  we  are  dealing  with  so 
powerful  a  drug  as  cocain. 

Neurocain. — Neurocain  is  a  name  given  to  billets  of  cocain 
hydrochlorid,  each  containing  1/12  gr.  (0.005  gm-)>  without  excipient. 
The  billets  are  1/8  inch  long,  1/20  inch  in  diameter,  and  very  soluble 
in  water.  Cocain  hydrochlorid  is  put  up  in  this  form  expressly  for 
dentists'  use  in  the  removal  of  the  pulp  by  pressure  anesthesia.  They 
are  convenient  for  this  purpose,  especially  where  it  is  desired  to  dis- 
solve the  local  anesthetic  in  the  serum  of  the  blood  in  cases  of  pulp 
exposure.  ' 

Incompatibles. — Cocain  hydrochlorid  is  incompatible  with 
alkalies  and  alkaline  carbonates  and  all  alkaloidal  reagents.  The 
drug  is  decomposed  by  boiling  water. 

Tropacocain  Hydrochlorid. — Tropacocain  is  an  alkaloid  obtain- 
ed from  the  leaves  of  the  Java  coca  plant.  It  occurs  as  white  needles, 
readily  soluble  in  water.  In  its  action  it  resembles  cocain,  but  is  less 
toxic  and  does  not  produce  contraction  of  the  blood-vessels.  Its  local 
anesthetic  property  is  not  sufficiently  profound  to  merit  employment 
as  such  in  dental  practice. 

Ever  since  cocain  has  been  used  as  a  local  anesthetic  in  dental  and 
general  surgery  numerous  attempts  have  been  made  by  manufacturing 
chemists  to  prepare,  synthetically,   substitutes  for  the  drug;  among 


EUCATNA.  [2<J 

which  may  be  mentioned  the  following:  The  eucains,  acoin,  nirvanin, 
stovain,   chlorctone,   and   novocain.     Many   of   these   products    \ 
short-lived  and  failed  to  fill  the  place  for  which  they  were  introduced, 
viz.,  to  displace  cocain  as  a  local  anesthetic.     Those  which  proved  to 
possess  merit  will  here  be  discussed. 

EUCAINA— Unofficial. 
(Kucain;  CI2HI2N02(CH3)3. 

Eucain  is  a  synthetic  product  and  was  placed  upon  the  market  at 
first  as  "  Alpha-eucain"  and  "Beta-eucain,"  two  closely  allied  bases, 
differentiated  as  eucain  "A"  and  eucain  "14."  The  former  has  been 
withdrawn  from  the  American  market,  while  the  latter  is  used  quite 
extensively  in  dentistry  as  a  local  anesthetic  in  the  form  of  beta-eucain 
hydrochlorid. 

BETA-EUCAINiE  HYDROCHLORIDUM— Unofficial. 

(Beta-eucain  Hydrochlorid;  Eucain    Hydrochlorid  B; 

(CI2HI2N02(CH3)3C1.) 

Beta-eucain  hydrochlorid  occurs  as  a  white  crystalline  powder, 
soluble  in  20  to  30  parts  of  water  at  the  ordinary  temperature,  more 
soluble  in  warm  water,  soluble  in  25  to  30  parts  of  alcohol.  The 
solutions  are  neutral  and  can  be  sterilized  by  boiling  without  change. 

Physiologic  Action  and  Therapeutics. — Eucain  is  a  local 
anesthetic,  like  cocain,  but  weaker  and  devoid  of  the  stimulating  action 
of  the  latter.  It  does  not  dilate  the  pupil,  and  it  differs  from  cocain  in 
that  it  does  not  produce  eschemia  by  the  contraction  of  the  blood 
vessels.  By  some  this  is  claimed  to  be  an  advantage,  as  it  permits  more 
profuse  hemorrhage  after  operating,  and  thus  it  is  supposed  some  of  the 
drug  is  carried  out  of  the  part  and  does  not  enter  the  circulation.  The 
solutions  of  beta-eucain  hydrochlorid  have  the  one  distinct  advantage 
of  being  stable  even  on  prolonged  boiling.  The  drug  may  be  used  in 
almost  all  cases  where  cocain  is  indicated.  A  2  per  cent,  solution  being 
about  the  strength  used  for  the  painless  extraction  of  teeth. 

Incompatibles.-  -Alkalies  and  their  carbonates  and  alkaloidal 
reagents. 

NOVOCAINS  HYDROCHLORIDUM— Unofficial. 
(Novocain  Hydrochlorid;  C^H^O.N.Cl.) 

Novocain  hydrochlorid   is  a  synthetic  product,  and  occurs  in 
colorless  needle-shaped  crystals,  readily  soluble  in  water  (1  part)  and 
9 


130  LOCAL    ANESTHETICS. 

less  soluble  in  alcohol  (30  parts).  The  aqueous  solutions  of  the  salt 
are  neutral  and  may  be  boiled  without  decomposition. 

Physiologic  Action  and  Therapeutics. — Novocain  is  claimed 
to  be  far  less  toxic  than  any  of  the  synthetic  substitutes  for  cocain. 
It  is  unirritating,  but  when  injected  beneath  the  skin  or  mucous 
membrane  it  exerts  a  prompt  and  powerful  local  anesthetic  action. 
This  effect,  however,  is  not  long  sustained,  but  may  be  overcome  by 
the  simultaneous  injection  of  the  suprarenal  alkaloid  (adrenalin). 
To  Prinz  probably  is  due  more  than  to  any  other  one  man  the  place 
which  novocain  occupies  in  dental  practice  to-day.  If  combined  with  a 
fresh  solution  of  adrenalin  chlorid,  the  drug  may  be  employed  as  a 
local  anesthetic  wherever  cocain  is  indicated. 

Incompatibles. — Novocain  hydrochlorid  is  incompatible  with 
alkalies  and  their  carbonates  and  all  alkaloidal  reagents. 

CHLORETONE. 

(Chlorbutanol;  C2Cl3(CH3)2OH.) 

Chloretone  is  a  synthetic  product,  and  occurs  as  a  white  crystal- 
line powder,  with  a  camphoraceous  odor  and  taste.  It  is  sparingly 
soluble  in  water,  but  freely  so  in  alcohol  and  ether.  The  dose  is  from 
5-20  gr.  (0.3-1.3  gm.). 

Physiologic  Action  and  Therapeutics. — Chloretone,  when  first 
introduced,  was  claimed  to  have  marked  local  anesthetic  properties 
and  was  recommended  as  a  substitute  for  cocain.  The  local  anes- 
thetic property,  however,  proved  to  be  rather  feeble.  The  drug  may 
be  classed  as  a  local  anodyne  and  antiseptic,  and  also  acts  when  taken 
internally  as  a  somnifacient.  Its  use  in  dentistry  is  largely  that  of 
an  antiseptic,  and  it  is  added  as  a  preservative  of  solutions  of  organic 
compounds,  such  as  cocain  and  adrenalin. 

ORTHOFORMUM— Unofficial. 

(Orthoform;    Methyl  Meta-Amido-Para-Oxybenzoate;  C8H903N.) 

Orthoform  is  a  synthetic  compound,  and  is  the  methyl  ester 
of  meta-amido-para-oxybenzoic  acid.  It  occurs  in  a  fine,  white,  or 
yellowish-white,  crystalline  powder,  neutral  in  reaction,  odorless  and 
tasteless.  It  is  practically  insoluble  in  water,  but  soluble  in  5  or  6 
parts  of  alcohol  and  in  50  parts  of  ether.  The  dose  is  from  8-15  gr. 
(0.5-1.0  gm.). 

Physiologic  Action  and  Therapeutics. — Orthoform  is  a  local 
anesthetic,  and  in  its  local  action  closely  resembles  cocain,  but  differs 


GENERA]     ANESTHETICS. 

from  the  latter  in  that  it  does  not  penetrate  the  tissue  on  account  of 
its  insolubility.  It  has  practically  no  action  on  the  unbroken  skin  or 
mucous  membrane  and  produces  no  irritation  except  slight  corrosion 
about  the  site  to  which  it  is  applied.  The  drug  is  mildly  antiseptic 
and   practically  nontoxic  in  the  usual  dos(  \-  an  anodyne  remedy 

for  painful  wounds  or  abraded  surfaces  it  is  an  absolute  specific. 
Mawhinney  suggests  using  equal  parts  of  orthoform  and  europhen 
as  a  dusting  powder  for  burns,  exposed  alveolar  process  after  extraction. 
etc.  It  can  be  handled  more  conveniently  in  the  mouth  if  a  paste  be 
made  of  the  mixture  of  orthoform  and  europhen,  using  liquid  petro- 
leum as  the  vehicle.  Plain  aseptic  gauze  may  be  saturated  with  this 
paste  and  carefully  packed  into  painful  sockets  after  extraction,  covering 
the  exposed  process  and  lacerated  tissue  with  the  oleaginous  paste. 
The  same  packing  is  excellent  after  root  amputation  and  other  minor 
operations  about  the  jaws. 

Incompatibles. — Orthoform  is  decomposed  by  boiling  water, 
and  incompatible  with  alkalies  and  their  carbonates. 

GENERAL  ANESTHETICS. 

The  detail  technic  of  the  administration  of  general  anesthetics 
is  a  topic  of  sufficiently  great  importance  as  to  merit  discussion  in  a 
separate  volume  by  specialists  in  this  line  of  work.  Several  excellent 
books  covering  this  phase  of  general  anesthetics  are  on  the  market. 

In  our  discussion  of  the  drugs  grouped  under  this  heading,  the 
author  will  confine  himself  largely  to  materia  medica  proper.  The 
description  of  the  drugs,  their  general  action,  and  the  indication  or 
contraindication  for  their  use  are  subjects  which  should  naturally 
be  considered  in  a  work  of  this  kind.  The  most  important  general 
anesthetics  are: 

Nitrous  Oxid.  Chloroform. 

Ether.  Ethyl  Chlorid* 

Ethyl  Bromid. 

NITROUS  OXID. 
(Nitrogen  Monoxid;  Laughing  (las;  X..O.) 

Nitrous  oxid  is  a  gas  prepared  by  carefully  heating,  in  a  proper 
apparatus,  ammonium  nitrate.  The  gas  is  collected  over  water  and 
purified  by  running  it  through  a  series  of  wash-bottles.  It  is  colorless, 
odorless,   and  possessing  a  somewhat  sweetish   taste.     By  cold  and 


132  GENERAL   ANESTHETICS. 

pressure  it  is  converted  into  a  liquid,  when  it  is  usually  placed  in  iron 
cylinders  and  kept  for  subsequent  use.  When  the  gas  is  administered 
many  times  daily,  as  with  extraction  specialists,  it  is  best  to  manu- 
facture the  gas  fresh  each  morning  and  store  it  in  an  ordinary  gas 
tank  for  this  purpose. 

Physiologic  Action. — Nitrous  oxid  is  the  safest  known  general 
anesthetic.  It  is  nonirritating  when  inhaled,  but  produces  an  increase 
of  blood-pressure,  a  sense  of  exhilaration,  ringing  in  the  ears,  and 
lividity  of  the  face;  in  about  one  minute,  if  the  gas  is  undiluted  with 
oxygen,  these  symptoms  are  followed  by  complete  unconsciousness. 
The  muscles  are  not  fully  relaxed,  and  the  conduct  of  the  patient 
while  under  the  influence  of  the  gas  depends  largely  upon  the  confi- 
dence the  patient  reposes  in  the  anesthetist.  Excitement,  laughing, 
crying,  a  pugilistic  tendency,  though  all  done  unconsciously,  are 
often  indulged  in.  It  is  claimed  that  the  anesthesia  is  induced  by  a 
twofold  action:  the  temporary  displacement  of  oxygen  from  the 
blood,  and  the  direct  action  of  the  gas  on  the  cerebrum.  The  recovery 
is  almost  instantaneous  upon  the  removal  of  the  anesthetic  agent. 
When  the  gas  is  mixed  with  air  or  pure  oxygen  the  excitement  is  apt  to 
be  greater  and  the  anesthetic  effect  more  slowly  produced. 

Therapeutics. — Nitrous  oxid  is  the  ideal  general  anesthetic  for  all 
minor  surgical  operations.  Indeed,  the  gas  mixed  in  proper  propor- 
tions with  pure  oxygen  is  fast  gaining  a  reputation  for  operations 
in  major  surgery.  By  this  means  the  patient  may  be  kept  under  the 
influence  of  the  anesthetic  for  hours.  Much  credit  is  due  Teter,  of 
Cleveland,  Bevan,  and  Ream,  of  Chicago,  and  others,  for  developing 
the  technic  and  encouraging  the  use  of  prolonged  anesthesia  by  nitrous 
oxid  and  oxygen. 

Many  dental  operations,  like  the  preparation  of  cavities  in  sensitive 
teeth,  opening  abscesses,  removing  partially  decalcified  pulp  tissue,  etc., 
may  be  performed  absolutely  without  pain  under  the  influence  of 
nitrous  oxid,  carried  to  the  analgesic  stage. 

.ETHER— U.   S.  P. 
(Ether;  Ethyl  Oxid;  (C2Hs)20.) 

Ether  is  made  by  the  action  of  sulphuric  acid  on  ethyl  alcohol.  It 
is  a  transparent,  colorless,  mobile,  and  very  volatile  liquid,  having  a 
characteristic  odor  and  a  burning,  sweetish  taste.  Freely  soluble  in 
alcohol,  chloroform,  oils,  and  in  about  ten  times  its  volume  of  water. 
Ether  is  highly  inflammable,  its  vapor,  when  mixed  with  air  and  ignited, 


ETHER.  133 

explodes  violently.  It  should  be  kept  in  well  stoppered  containers, 
preferably  in  tin  cans,  in  a  cool  place,  away  from  lights  or  fire.  The 
official  product  contains  about  4  per  cent,  of  alcohol.  The  dose  is 
15  min.  (1.0  c.c);  for  anesthesia  about  1 11.  oz.  (30.0  c. c.)  The  follow- 
ing preparations  are  official: 

Spiritus  /Etheris,  U.  S.  P.     Dose,  about  1  fl.  dr.  (4.0  c.c). 
Spiritus  .Etheris  Compositus,  U.  S.  P.  (Hoffmann's  Anodyne). 
Dose,  1/2-1  fl.  dr.  (2.0-4.0  c.c). 

Physiologic  Action. — When  applied  to  the  skin,  mucous  mem- 
brane, or  tooth-structure,  ether  produces  intense  cold  by  its  rapid 
evaporation,  and  acts  as  a  refrigerant  local  anesthetic.  If  it  is  confined 
on  soft  tissue,  great  irritation  results.  When  inhaled  as  a  general 
anesthetic,  it  irritates  the  mucous  membrane  of  the  respiratory  tract, 
and  at  first  coughing,  choking,  and  a  sense  of  strangulation  follow. 
These  symptoms  are  soon  overcome,  and  complete  loss  of  conscious- 
ness marks  the  subsequent  stage  of  anesthesia,  when  total  relaxation 
supervenes,  accompanied  by  gentle,  regular  breathing.  The  drug  is 
eliminated  chiefly  by  the  lungs  and  kidneys;  on  the  latter  organs  it 
has  an  irritant  effect,  therefore  it  should  be  employed  cautiously  as 
a  general  anesthetic  in  cases  of  nephritis. 

Therapeutics. — Ether  is  used  largely  as  a  general  anesthetic,  and, 
when  thus  administered  for  dental  purposes,  it  had  better  be  given  by 
an  experienced  anesthetist.  The  ether  spray  is  used  for  obtunding 
sensitive  dentin.  This  requires  a  specially  designed  apparatus.  Good 
results  can  also  be  immediately  obtained  by  adjusting  the  rubber  dam 
and  evaporating  the  following  remedy,  applied  to  the  cavity  on  a  small 
pledget  of  cotton:  Cocain,  20  gr.  (1.3  gm.);  chloroform,  2  fl.  dr. 
(8.0  c.c.).;  ether,  6  fl.dr.  (24.0  c.c).  Ether  is  a  valuable  solvent  for 
many  substances  insoluble  in  water,  such  as  resins  and  oils. 

The  spray  may  also  be  used  as  a  local  anesthetic,  preliminary  to 
opening  abscesses,  but  it  is  inferior  to  ethyl  chlorid  for  this  purpose. 

The  compound  spirit  of  ether  may  be  mixed  with  an  equal  volume 
of  camphorated  tincture  of  opium  (paregoric)  and  given  in  doses  of  1 
fl.  dr.  (4.0  c.c.)  to  check  diarrhea  in  hot  weather.  The  compound  spirit 
of  ether  is  a  useful  remedy  as  an  antispasmodic  in  children  with  compli- 
cations of  first  dentition. 

Contraindications. — Ether  is  contraindicated  as  a  general 
anesthetic  in  cases  of  advanced  arteriosclerosis;  tuberculosis  with 
a  tendency  to  hemorrhage;  acute  and  chronic  diseases  of  the  kid- 
neys; anemia,  when  the  hemoglobin  is  less  than  30  per  cent.;  diabetes, 


134  GENERAL   ANESTHETICS. 

especially  when  well  established.     Death  from  ether  usually  results 
from  asphyxia. 

CHLOROFORMUM— U.  S.  P. 

(Chloroform;  Methyl  Trichlorid;  CHC13.) 

Chloroform  is  made  for  commercial  purposes  by  the  action  of 
chlorin  on  alcohol.  It  is  a  heavy,  clear,  colorless,  mobile,  and  dif- 
fusible liquid,  having  a  characteristic  odor  and  a  burning  taste. 
Soluble  in  about  200  times  its  volume  of  cold  water,  and  in  all  propor- 
tions in  alcohol,  ether,  and  oils.  It  is  not  inflammable,  but  its  heated 
vapor  burns,  emitting  a  green  flame.  It  should  be  kept  in  amber- 
colored,  glass-stoppered  bottles,  in  a  dark,  cool  place.  The  dose  is 
from  5-30  min.  (0.3-2.0  c.c);  for  anesthesia,  about  1/2  fl.  oz.  (15.0  c.c). 
The  following  preparations  are  official: 

Aqua  Chloroformi,  U.  S.  P.     Dose,  1/2-2  fl.  oz.  (15.0-60.0  c.c). 
Spiritus  Chloroformi,  U.  S.  P.     Dose,  20-60  min.  (1 .3-4.0  c.c). 
Linimentum  Chloroformi,  U.  S.  P.  (externally). 
Emulsum  Chloroformi,  U.  S.  P.     Dose,  1/2-1  fl.  oz.  (15. 0-30.0 c.c). 

Physiologic  Action. — When  applied  to  the  skin  or  mucous 
membrane  locally,  chloroform  produces  a  sense  of  coldness  by  its 
rapid  evaporation.  If  confined,  it  causes  redness  and  even  vesication. 
When  inhaled  it  produces  general  anesthesia;  the  phenomena  observed 
may  be  grouped  under  three  stages,  and  are  described  by  Stevens1  as 
follows:  The  first  stage  is  characterized  by  excitement,  muscular 
rigidity,  and  lessened  sensibility  (analgesia) ;  the  second  by  anesthesia 
and  muscular  relaxation;  and  the  third  by  stertorous  breathing, 
abolition  of  reflexes,  profound  narcosis,  and  absolute  muscular 
relaxation. 

The  drug  is  eliminated  practically  unchanged  through  the  lungs 
and  kidneys,  and  while  it  irritates  the  latter  organs,  its  deleterious 
effects  are  less  pronounced,  owing  to  the  smaller  quantity  necessary 
to  induce  profound  anesthesia. 

Therapeutics. — Chloroform  is  a  rapid  and  agreeable  general 
anesthetic.  It  is  far  more  dangerous  than  ether,  the  mortality  being 
five  times  greater,  and  should  never  be  administered  as  a  general 
anesthetic  except  by,  or  in  the  presence  of,  an  experienced  anesthetist. 

With  the  patient  in  the  upright  position,  chloroform  may  be  car- 
ried to  the  analgesic  stage,  and  sensitive  cavities  prepared,  deciduous 
teeth  extracted,  or  abscesses  lanced.     Most  authorities  agree,  however, 

1  Modern  Materia  Medica  and  Therapeutics. 


.1.1  II  VI  IS    BR0MID1   \l. 

that  the  drug  should  not  be  inhaled  by  the  patient  unless  in  the  recum- 
bent position,  and  that  the  analgesic  stage  is  the  most  dangerous.  It  is 
the  safest  practice  to  refrain  from  using  the-  drug  in  this  manner. 
except  perhaps  in  special  cases. 

Chloroform  is  a  constituenl  of  many  liniments  used  for  counter 
irritation  in  cases  of  pericementitis  and  neualgia.  The  drug  itself  may 
be  confined,  and  redness  and  even  vesication  follow.  It  has  long  been 
used  as  a  solvent  for  gutta  percha,  forming  a  solution  known  as 
chloropercha,  used  in  filling  root-canals.  Like  ether,  the  agent  is  used 
also  as  a  solvent  for  many  otherwise  insoluble  substances. 

The  liniment  of  chloroform  lias  been  extensively  used  as  a  stimu- 
lating remedy  in  muscular  rheumatism,  sprains,  and  bruises. 

Indications  and  Contraindications. — Chloroform,  though  more 
dangerous  than  ether,  is  to  be  preferred  to  the  latter  as  a  general 
anesthetic  in  all  acute  inflammatory  diseases  of  the  bronchi  or  lungs, 
advanced  diseases  of  the  blood-vessels,  acute  and  chronic  diseases  of 
the  kidneys.  In  the  extraction  of  teeth  ether  is  considered  the  safer 
anesthetic;  chloroform  being  more  apt  to  cause  cardiac  paralysis, 
reflexly  by  way  of  the  superior  or  inferior  dental  nerve.  Chloroform 
is  contraindicated  in  all  cardiac  diseases,  and  if  administered  here 
must  be  done  cautiously.  Death  from  chloroform  usually  results  from 
circulatory  failure. 

As  has  been  stated,  the  drug  is  pleasant  to  inhale,  and  many  in- 
dividuals have  the  chloroform  habit. 

jETHYLIS  BROMIDUM— Unofficial. 

(Ethyl  Bromid;  Hydrobromic  Ether;  C2H5Br.) 

Ethyl  bromid  is  made  by  heating  a  mixture  of  ethyl  alcohol, 
sulphuric  acid,  and  potassium  bromid.  When  pure,  it  occurs  as  a 
colorless,  highly  volatile  liquid,  having  an  odor  resembling  chloroform 
and  a  sweetish  taste.  It  is  inflammable,  and  on  exposure  to  air  it 
liberates  bromin  and  hydrobromic  acid  and  becomes  unfit  for  use.  It 
should  be  kept  in  dark  amber-colored  bottles,  tightly  stoppered.  The 
dose  as  a  general  anesthetic  is  from  1-6  dram-  (4.0-24.0  c.c),  depend- 
ing upon  the  age  and  condition  of  the  patient. 

Physiologic  Action  and  Therapeutics. — As  a  general  anesthetic, 
ethyl  bromid  somewhat  resembles  the  action  of  chloroform.  It  acts 
more  quickly,  however,  and  is  less  depressing,  and  its  effects  less  lasting. 
It  may  be  used  for  short  operations,  but  has  nothing  to  recommend  its 
employment  over  nitrous  oxid,  except  it  does  not  require  a  cumber- 
some apparatus  for  its  administration. 


I36  ANTIPYRETICS. 

Those  drugs  not  included  in  this  group,  which  possess  general 
analgesic  or  anodyne  properties,  will  be  considered  under  other  head- 
ings in  the  following  pages. 

ANTIPYRETICS. 

Antipyretics,  called  also  febrifuges,  are  drugs  which  reduce  the 
body  temperature  when  abnormally  high.     This  group  includes : 

Coal-tar  Derivatives:  Cinchona,   especially   its   al- 

Antipyrin.  kaloid,   Quinin. 

Acetanilid. 
Phenacetin. 

ANTIPYRINA— U.   S.    P. 

(Antipyrin;  C6H5(CH3)2C3HN20.) 

Antipyrin  is  a  coal-tar  derivative,  basic  in  character,  obtained  by 
the  condensation  of  phenyl  hydrazin  with  diacetic  ether  and  methyl- 
ization  of  the  product.  It  occurs  as  a  white,  crystalline  powder  or 
scales,  odorless,  of  a  slightly  bitter  taste,  freely  soluble  in  water,  alcohol, 
and  chloroform.     The  dose  is  from  3-15  gr.  (0.2-1.0  gm.). 

Physiologic  Action. — Antipyrin  has  no  action  on  the  unbroken 
skin.  It  first  irritates  and  then  blanches  mucous  membranes,  resulting 
in  an  analgesic  effect.  It  may  be  considered  a  mild  antiseptic,  and 
applied  locally  to  abraded  surfaces  it  contracts  the  blood-vessels  and 
acts  as  a  mild  styptic.  Internally  administered,  it  reduces  abnormally 
high  temperatures,  as  in  fevers,  but  has  practically  no  action  in  health. 
The  drug  here  dilates  blood-vessels  and  increases  perspiration,  and  thus 
the  heat  reduction  is  brought  about.  Antipyrin  differs  from  other 
anilin  derivatives  (acetanilid)  in  that  it  has  no  appreciable  action  upon 
the  blood  itself,  and  in  this  respect  it  is  a  much  safer  analgesic. 

Therapeutics. — Antipyrin  is  a  comparatively  safe  and  useful 
drug  in  all  conditions,  the  treatment  of  which  calls  for  the  relief  of  pain. 
Some  authorities  place  it  next  to  opium  as  a  general  analgesic.  The 
drug  may  be  given  in  powdered  form  or  in  solution  for  the  relief  of  pain 
of  a  neuralgic  character,  and  whenever  it  is  desirable  to  lower  temperature 
in  fever.  As  an  antispasmodic,  it  is  useful  in  the  childhood  period  of 
tooth  eruption,  in  whooping-cough,  etc.  Here  it  may  be  taken  in  com- 
bination with  a  bromid.  The  following  may  be  given  in  teaspoonful 
doses,  further  diluted  with  water,  to  a  child  three  years  old,  varying 
the  dose  according  to  the  age:  Antipyrin,  45  gr.  (3.0  gm.);  sodium 
bromid,  1  1/2  dr.  (6.0  gm.);  glycerin,  1/2  fl.  oz.  (15.0  c.c);  pepper- 


aci:i  \mi  1 1 'i  m.  137 

mint  water,  2  1  2  8.  OZ.  1  75.0  c.c).  In  capillary  oozing  after  operations, 
the  drug  may  he  applied  locally  in  powdered  form,  or  a  20  to  30  per 
cent,  solution,  which  is  less  irritating. 

Incompatibles.  Antipyrin  is  incompatible  with  tincture  of 
iodin,  mercuric  and  mercurous  chlorid,  the  ferric  salts  in  solution, 
phenol,  chloral,  beta-naphthol,  sodium  bicarbonate,  sodium  salicylate, 
orthoform,  spirit  of  nitrous  ether,  and  the  salts  of  quinin  and  caffein. 
The  wide  range  of  incompatibles  is  due  to  the  basic  properties  of  the 
drug. 


ACETANILIDUM— U.  S.  P. 
(Acetanilid;  Antifebrin;  C6H5NH.C2H30.) 

Acetanilid  is  a  coal-tar  product,  derived  from  anilin,  an  atom 
of  hydrogen  in  the  latter  being  replaced  by  the  acetic  acid  radical.  It 
occurs  as  a  white,  shining,  crystalline  powder,  without  odor,  of  a 
faintly  burning  taste,  sparingly  soluble  in  water,  freely  in  alcohol  and 
chloroform,  and  somewhat  less  so  in  ether.  The  dose  is  from  2-10  gr. 
(0.13-0.65  gm.).     There  is  one  official  preparation: 

Pulvis  Acetanilidi  Compositus,  U.  S.  P.  (Compound  Acetanilid 
Powder;  Acetanilid,  70  parts;  Caffein,  10  parts;  Sodium  Bicar- 
bonate, 20  parts).     Dose,  7  1/2  gr.  (0.5  gm.). 

Physiologic  Action. — Like  antipyrin,  in  moderate  doses  in 
health  acetanilid  has  no  perceptible  effect.  Internally  administered 
in  fever,  the  drug  produces  marked  fall  of  temperature,  due,  in  all 
probability,  to  its  direct  influence  on  the  centers  which  regulate  heat- 
production.  Free  perspiration  frequently  accompanies  the  fall  of 
temperature.  In  large  doses  acetanilid  acts  as  a  cardiac  depressant 
and  induces  blood-changes.  The  blood  assumes  a  chocolate  color, 
due  to  the  production  of  methemoglobin.  It  is,  therefore,  not  as  safe 
an  analgesic  as  antipyrin,  though  exerting  a  greater  influence  over  the 
nerve  centers  which  control  pain.  Applied  locally  to  mucous  mem- 
branes or  abraded  surfaces,  the  drug  is  nonirritating  and  exerts  an 
analgesic  effect  by  depressing  the  sensory  nerve-endings. 

Poisoning  and  Treatment. — The  symptoms  of  poisoning  by 
acetanilid  are  marked  cyanosis,  feeble  breathing,  pulse  soft,  slow, 
later  rapid  and  weak,  free  perspiration,  pupils  dilated  and  ultimate 
collapse.  In  the  treatment  of  poisoning  the  body  temperature  should  be 
maintained  by  external  heat  and  such  cardiac  and  respiratory  stimu- 
lants given  as  strychnin  sulphate,  ammonia,   and   atropin    sulphate 


1 38  ANTIPYRETICS. 

In  combating  the  cyanosed  condition  inhalations  of  pure  oxygen  and 
artificial  respiration  are  important. 

Therapeutics. — Acetanilid,  judiciously  employed,  is  a  valuable 
drug  for  the  relief  of  pain  in  many  diseased  dental  conditions,  such  as 
acute  abscess,  neuralgia,  headache,  etc.  It  is  always  best  to  combine 
the  drug  with  a  stimulant  to  overcome  the  depressant  effect  of  ace- 
tanilid upon  the  heart.  In  the  official  powder,  caffein  is  added  for 
this  purpose.  Harlan  suggested  a  formula  wherein  whisky  was 
added  as  the  cardiac  stimulant.  It  is:  Acetanilid,  10  gr.  (0.65  gm.); 
simple  syrup,  1/2  fl.  oz.  (15.0  c.c);  whisky,  2  1/2  fl.  oz.  (75.0  c.c). 
The  compound  powder,  which  can  be  obtained  in  tablets,  is  an  ex- 
cellent form  in  which  to  administer  the  drug. 

The  drug  may  be  cautiously  applied  locally  in  powdered  form  in 
the  treatment  of  wounds,  burns,  ulcers,  or  other  abraded  surfaces,  but  is 
far  inferior,  as  a  local  analgesic,  to  orthoform. 

ACETPHENETIDINUM— U.  S.  P. 

(Acetphenetidin;  Phenacetin;  C6H4OC2H5.NHC2H30.) 

Acetphenetidin  commonly  called  phenacetin,  is  a  coal-tar  prod- 
uct obtained  by  the  action  of  glacial  acetic  acid  on  paraphenetidin 
(an  anilin  derivative),  one  atom  of  hydrogen  in  the  latter  being  re- 
placed by  the  acetic  acid  radical.  It  occurs  as  white,  glistening, 
crystalline  scales  or  fine  powder,  without  odor  or  taste,  sparingly 
soluble  in  water,  but  freely  so  in  alcohol  and  glycerin.  The  dose  is 
from  5-10  gr.  (0.3-0.65  gm.). 

Physiologic  Action  and  Therapeutics. — Internally  administered, 
phenacetin  exerts  a  similar  action  to  that  produced  by  antipyrin  and 
acetanilid,  though  all  authorities  claim  that  it  is  far  less  toxic  than 
either  of  these  drugs.  Everything  considered,  it  is  the  most  satis- 
factory of  all  of  the  coal-tar  antipyretics.  Probably  the  only  objection 
that  may  be  offered  to  its  use  is  that  it  is  more  expensive  than  antipyrin 
or  acetanilid,  but  when  its  safety  is  considered  even  this  possible  ob- 
jection is  outweighed.  It  may  be  advantageously  employed  in  all 
cases  where  the  other  coal-tar  analgesics  have  been  mentioned.  A 
useful  formula  is  the  combination  of  phenacetin  and  codein  sulphate 
in  the  proportion  of  5  gr.  (0.3  gm.)  of  the  former  to  1 1 2  gr.  (0.03  gm.)  of 
the  latter  for  an  adult  dose. 

Though  the  actions  of  antipyrin,  acetanilid,  and  phenacetin  are 
similar,  frequently  results  are  obtained  by  the  use  of  one  of  the  drugs 
where  the  others  have  failed. 


CINCHONA.  [39 

CINCHONA     U.    S.  P. 
Peruvian   Bark.) 

Cinchona  is  the  dried  hark  of  Cinchona  calisaya,  Cinchona  ledger- 
iana,  Cinchona  officinalis,  and  several  other  species  of  Cinchona,  tall 
evergreen  trees  "indigenous  to  South  America,  and  now  cultivated  in 
Ceylon,  Java,  and  Jamaica.  The  specimen  should  yield  not  less 
than  5  per  cent,  of  total  anhydrous  cinchona  alkaloids,  of  which  there- 
are  several;  the  most  important  are  </iti>ii>i,  quinidin,  cinchonin  and  cm- 
chonidin.  It  should  also  contain  not  less  than  4  per  cent,  of  anhy- 
drous ether-soluble  alkaloids.  The  following  preparation-  are 
official: 

Fluidextractum  Cinchonae,  U.  S.P.     Dose,  1/2-1  fl.  dr.  (2.0-4.0 

c.c). 

Tinctura  Cinchonas,  U.  S.  P.     Dose,  1-2  fl.  dr.  (4.0-8.0  c.c). 

Tinctura  Cinchonae  Composite,  U.  S.  P.  (Huxham's  Tincture; 

Red    Cinchona,    10;    Bitter   Orange   Peel,    8;    Serpentaria,  2). 

Dose,  1-4  fl.  dr.  (4.0-15.0  c.c). 

Several  of  the  alkaloids  and  their  salts  are  also  official.     They  are: 

Quinina,  U.  S.  P.     Dose,  1-10  gr.  (0.06-0.65  gm.). 

Quininae  Sulphas,  U.  S.  P.     Dose,  1-20  gr.  (0.06-1.3  om-)- 

Quininae  Bisulphas,  U.  S.  P. 

Quininae  Hydrochloridum,  U.  S.  P.  [  Dose,  1-15  gr.  (0.06-1.0  gm.). 

Quininae  Hydrobromidum,  U.  S.  P.  J 

Quininae  Salicylas,  U.  S.  P.     Dose,  1-10  gr.  (0.06-0.65  Sm-)- 

Oleatum  Quininae,  U.  S.  P.  (25  per  cent.).     Externally. 

Cinchoninae  Sulphas,  U.  S.  P.       I   _ 

Cinchonidinae  Sulphas,  U.  S.  P.  J  Dose>  l~2°  ^  (oo6"1  3  gm.). 

Inasmuch  as  quinin  is  the  most  important  alkaloid  of  cinchona 
and  represents  largely  its  active  properties,  it  will  be  the  only  constitu- 
ent here  described. 

QUININA,  U.  S.  P. 

(Quinin.) 

Quinin  occurs  as  a  white,  flaky,  amorphous  or  crystalline  powder, 
odorless,  and  of  an  extremely  bitter  taste.  It  is  practically  insoluble 
in  water,  but  is  readily  soluble  in  acidulated  water,  alcohol,  and  ether. 

Physiologic  Action. — Quinin  acts  differently  upon  different 
individuals.  In  large  doses,  and  with  some  subjects  in  comparatively 
small  doses,  it  causes  a  sense  of  fullness  in  the  head,  ringing  in  the  ears, 
deafness,  headache,  and  sometimes  dimness  of  vision.     This  group 


140  HYPNOTICS. 

of  symptoms  is  included  in  the  term  cinchonism.  The  drug  is  absorbed 
chiefly  from  the  stomach,  and  its  action  augments  the  secretions 
from  the  salivary  and  gastrointestinal  glands;  it,  therefore,  may  be 
considered  a  stomachic  and  tonic.  Through  the  kidneys  is  the  prin- 
cipal mode  of  elimination.  Butler1  states  that  quinin  has  a  remark- 
able effect  upon  the  constituents  of  the  blood.  The  ameboid  move- 
ments of  the  white  blood-corpuscles  are  arrested,  preventing  them 
from  migrating  through  the  capillary  walls  in  inflammation. 
Full  doses  of  the  drug  also  diminish  the  white  blood-corpuscles, 
while  the  red  corpuscles  are  proportionately  increased.  Quinin 
diminishes  the  metabolism  of  the  body  by  lessening  the  oxygen-carry- 
ing power  of  the  red  blood-corpuscles.  Though  it  is  doubtful  that 
quinin  ever  directly  caused  the  death  of  a  human  being,  idiosyncrasies 
are  frequently  encountered.  Two  or  3  gr.  (0.13-0.2  gm.)  have  been 
known  to  produce  intense  cinchonism  in  some  individuals,  and 
quinin  rashes  are  not  uncommon.  The  drug  also  acts  as  an 
antiseptic  and  it  is  claimed  to  possess  local  anesthetic  properties. 

Therapeutics. —Quinin  has  been  used  extensively  as  a  domestic 
remedy  for  many  ills,  and  most  individuals  know  how  the  drug  affects 
them.  This  will  govern  the  dentist  in  regard  to  the  dose  to  be  admin- 
istered in  a  given  case.  The  drug  is  a  specific  for  malarial  fever,  and 
may  be  given  in  cases  of  neuralgias  associated  with  the  teeth;  especially 
is  it  indicated  here  in  malarial  regions  and  in  the  spring  of  the  year 
when  the  climate  is  more  or  less  damp.  The  author  prefers  quinin 
bisulphate,  as  it  is  more  soluble.  It  should  be  given  in  gelatin  capsules 
rather  than  in  the  dry,  hard,  pilular  form,  as  the  latter  may  pass  through 
the  stomach  undissolved.  The  drug  is  a  constituent  of  many  bitter 
tonics.  Quinin  sulphate  has  been  recommended  for  its  tonic  and 
antiseptic  properties  as  a  local  application  in  pyorrheal  pockets.  The 
bitter  taste  of  the  drug  makes  its  use  here  almost  prohibitive. 


HYPNOTICS. 

Hypnotics,  also  called  somnifacients,  are  agents  which   induce 
sleep.     The  chief  hypnotics  are: 

Chloral  Hydrate.  Paraldehyd. 

Butyl-chloral  Hydrate.  The  Bromids. 

Sulphonal.  Opium  (and  Alkaloids). 
Trional. 

1  Text-Book  of  Materia  Medica,  Therapeutics  and  Pharmacology. 


CHLORALUM  HYDKATUM.  141 

CHLORALUM  HYDRATUM -U.  S.  P. 
(Hydrated  Chloral;  Chloral;  C2HC1  <  I     II..O.) 

Hydrated  chloral  is  obtained  by  the  union  of  a  molecule  of  water 
with  trichloraldehyd,  commonly  called  chloral,  the  latter  being  pre- 
pared by  the  action  of  chlorin  ui)on  alcohol,  whence  the  name  chlor-al. 
Chloral  hydrate  is  the  official  preparation  and  the  only  one  used  in 
dentistry  or  medicine.  It  occurs  as  colorless,  transparent  crystals, 
having  an  aromatic,  penetrating  odor,  and  a  bitterish,  caustic  taste; 
freely  soluble  in  water,  alcohol,  ether,  and  chloroform.  It  liquefies 
when  triturated  with  an  equal  quantity  of  menthol,  thymol,  phenol, 
or  camphor.     The  dose  is  from  5-20  gr.  (0.3-1.3  gm.). 

Physiologic  Action. — Applied  locally,  chloral  hydrate  acts 
as  an  antiseptic,  mild  anesthetic  and  vesicant.  Even  when  applied 
to  the  unbroken  skin,  it  produces  redness  and  sometimes  vesication. 
Internally  administered  in  therapeutic  doses,  the  drug  induces  quiet 
sleep  of  a  natural  character.  The  chief  action  of  chloral  hydrate  is 
upon  the  nervous  system,  the  sleep  being  the  result  of  the  direct  in- 
fluence of  the  drug  over  the  cerebral  cells  which  lessens  reflex  activity 
by  depressing  the  motor  neurons  of  the  spinal  cord.  The  drug  is  elimi- 
nated principally  by  the  kidneys. 

Poisoning  and  Treatment. — The  symptoms  of  acute  choral 
poisoning  are  sleep,  deepening  into  coma.  The  pulse  is  feeble,  thready, 
and  irregular;  temperature  subnormal;  respiration  slow,  followed  by 
rapid  shallow  breathing,  and  ultimate  collapse.  Death  may  result 
from  either  cardiac  or  respiratory  paralysis.  In  the  treatment  of 
poisoning  the  temperature  should  be  maintained  or  restored  by  arti- 
ficial heat — warm  blankets,  hot  bottles,  etc.  Cardiac  and  respiratory 
stimulants,  like  strychnin,  ammonia,  atropin,  and  digitalis  should  be 
employed.  To  prevent  asphyxia,  inhalations  of  pure  oxygen  and 
artificial  respiration  should  be  resorted  to  early. 

Therapeutics. — The  principal  use  of  choral  hydrate  is  to  induce 
sleep  in  cases  of  insomnia.  It  is  especially  indicated  when  the  sleep- 
lessness results  from  overwork,  excitement,  fear,  or  dread.  It  should  not 
be  given  continuously  on  account  of  the  liability  to  form  habit.  As  a 
hypnotic  for  insomnia  resulting  from  pain,  the  drug  is  far  inferior  to 
opium.  On  account  of  the  powerful  depressant  effect  chloral  hydrate 
exerts  upon  the  motor  neurons  of  the  spinal  cord,  it  is  a  valuable  drug  in 
the  treatment  of  the  various  convulsions  and  spasmodic  disorders  of 
childhood,  such  as  the  complications  of  temporary  dentition.  iJiooping- 
cough,  etc.     Combined  with  potassium  bromid  it  is  considered  one  of 


[42  HYPNOTICS. 

the  best  sedatives  in  the  treatment  of  the  convulsions  of  tetanus  and 
strychnin  poisoning. 

Chloral  camphor,  a  clear,  syrupy  liquid,  can  be  made  by  triturat- 
ing equal  parts  of  chloral  hydrate  and  camphor.  This  remedy  may  be 
used  as  an  anodyne  in  cases  of  pulpitis,  and  in  neuralgia. 

Contraindications. — The  drug  is  contraindicated  in  cases  of 
marked  cardiac  and  respiratory  weakness. 

Incompatibles. — -Chloral  hydrate  is  incompatible  with  alkalies 
and  strong  solutions  of  antipyrin. 

Butyl-chloral  Hydrate. — This  product  is  produced  by  the  action 
of  chlorin  on  acetic  aldehyd,  hydrated  by  the  addition  of  water.  It 
occurs  in  white,  pearly  scales,  having  a  pungent  odor,  and  an  acid, 
disagreeable  taste.  It  is  practically  insoluble  in  water,  but  freely 
soluble  in  alcohol  and  glycerin.    The  dose  is  from  5-20  gr.  (0.3-1 .3  gm.) . 

Physiologic  Action  and  Therapeutics. — In  its  action,  butyl- 
chloral  hydrate  resembles  that  of  chloral  hydrate,  except  it  is  less 
powerful  as  a  hypnotic  and  more  irritant  to  the  stomach.  Authorities 
claim  that  the  fifth  or  trigeminal  nerve  is  especially  susceptible  to  the 
influence  of  butyl-chloral  hydrate,  and  the  drug  has  been  extensively 
used  in  the  treatment  of  trifacial  neuralgia  and  migraine.  The  drug 
is  best  given  in  the  form  of  capsules  on  account  of  its  disagreeable 
taste. 

Incompatibles. — -Butyl-chloral  hydrate  is  incompatible  with 
alkalies. 

SULPHONMETHANUM— U.  S.  P. 

(Sulphonmethane;  Sulphonal;  (CH3)2C(S02C2H5)2.) 

Sulphonal  is  a  synthetic  product  obtained  by  the  oxidation  of  a 
mixture  of  ethyl  hydrosulphid  and  acetone  (a  liquid  resembling  ethyl 
alcohol  in  its  action).  It  occurs  as  a  colorless,  odorless,  and  nearly 
tasteless,  crystalline  powder;  soluble  in  360  parts  of  cold  water,  in  15 
parts  of  boiling  water,  and  in  65  parts  of  cold  or  2  parts  boiling  alcohol. 
The  drug  is  stable  and  is  not  affected  by  strong  acids  or  alkalies. 
The  dose  is  from  15-30  gr.  (1.0  -2.0  gm.). 

Physiologic  Action. — Sulphonal  is  a  pure  hypnotic,  its  action 
as  such  being  intensified  by  combining  it  with  morphin  or  codein. 
It  has  no  depressant  effect  upon  the  heart,  but,  like  chloral  hydrate, 
it  acts  chiefly  on  the  nervous  system  by  depressing  the  cerebral  cortex; 
its  influence,  "however,  is  less  than  the  latter  drug  and  its  action  much 
slower,   due  to   its  insolubility  in  the  gastric  fluids.     The  hypnotic 


M    I  PH0N1   MINIMI    I  II  \\1    \1. 

effect  of  sulphonal  may  qoI  be  evidenced  for  several  hour.-,  alter  the 
administration  of  the  drug. 

Poisoning  and  Treatment.  The  symptoms  of  acute  sulphonal 
poisoning  are  headache,  vertigo,  marked  cyanosis,  vomiting,  diarrhea, 
respiration  -hallow,  pulse  feeble,  unconsciousness  and  final  collapse. 
Some  individuals  who  become  habitual  takers  of  this  class  of  drugs 
present  irregular  toxic  symptoms,  consisting  of  sleepiness  and  stupidity, 
loss  of  appetite  and  muscular  weakness.  With  some  papular  erup- 
tions are  not  uncommon.  The  treatment  of  acute  poisoning  consists 
in  the  discontinuance  of  the  drug;  the  administration  of  saline  cathar- 
tics, and  cardiac  and  respiratory  stimulants  as  indicated  by  the  symp- 
toms present. 

Therapeutics.  Sulphonal  is  used  internally  as  a  hypnotic.  It 
has  no  other  effect,  and  is  never  used  externally.  In  insomnia,  caused 
by  nervous  excitement,  grief,  or  overwork,  it  is  a  useful  hypnotic.  In 
insomnia  due  to  pain,  it  is  practically  worthless,  unless  combined  with 
the  alkaloids  of  opium.  Sulphonal  should  always  be  given  in  powder 
or  capsules  or  hot  whisky.  The  compressed  tablets,  unless  crushed, 
should  be  avoided  on  account  of  the  sparing  solubility  of  the  drug. 

SULPHONETHYLMETHANUM— U.   S.  P. 
(Sulphonethylmethan;    Trional;   C2H5.CH3.C(S02C2H5)2.) 

Trional  is-  a  synthetic  product  containing  three  ethyl  radicals, 
where  sulphonal  contains  but  two.  It  occurs  in  colorless,  lustrous, 
odorless,  and  almost  tasteless,  crystalline  scales;  soluble  in  195  part-  of 
cold  water,  and  freely  soluble  in  hot  water,  alcohol  and  ether.  The 
dose  is  from  15-30  gr.  (1.0-2.0  gm.). 

Physiologic  Action  and  Therapeutics.-  Trional  closely  re- 
semble- sulphonal  in  its  action.  Being  more  readily  soluble,  how- 
r,  the  drug  acts  more  quickly  and  has  a  tendency  to  accumulate  in 
the  body.  It  is,  therefore,  more  poisonous  than  sulphonal.  It  is 
best  administered  in  a  warm  vehicle,  such  as  milk,  tea,  or  brandy. 
The  treatment  of  poisoning  does  not  differ  from  that  of  sulphonal. 

'      PARALDEHYDUM— U.   S.  P. 
(Paraldehyd;  C6HI203.) 

Paraldehyd  is  a  synthetic  product  obtained  by  treating  aldehyd 
with  dilute  sulphuric  or  nitric  acid.  It  occurs  as  a  colorless  liquid. 
having  a  strong  ethereal  odor,  and  a  burning,  pungent  taste.  It  is 
soluble  in  8  parts  of  cold  water,  somewhat  less  so  in  hot  water,  and  is 


144  HYPNOTICS. 

miscible  in  all  proportions  with  alcohol,  ether,  chloroform,  and  the 
oils.     The  dose  is  from  1/2-1  fl.  dr.  (2.0-4.0  c.c). 

Physiologic  Action  and  Therapeutics. — Paraldehyd  resembles 
chloral  hydrate  in  its  action  in  that  it  depresses  the  brain  and  spinal 
cord.  It  differs  from  the  latter,  however,  in  that  its  depressant  action 
upon  the  heart  is  not  nearly  so  marked,  though  it  causes  a  noticeable 
fall  in  arterial  pressure.  The  drug  is  used  only  internally  as  a  hyp- 
notic, and  as  such  it  is  safe  and  reliable.  It  has  the  great  disadvantage 
of  being  difficult  to  mask  its  nauseating  taste,  and  its  disagreeable  odor 
is  imparted  to  the  breath  for  some  time  after  its  administration.  The 
symptoms  of  poisoning  and  the  treatment  of  the  same  are  similar  to 
chloral  hydrate.  As  a  hypnotic  in  dental  practice,  chloral  hydrate  is 
far  preferable  to  sulphonal,  trional,  or  paraldehyd. 

THE  BROMIDS. 

The  bromids  of  certain  metals,  notably  potassium,  sodium,  and 
ammonium,  might  well  be  discussed  under  different  headings;  but 
they  are  true  spinal  cord  depressants,  and  when  administered  produce 
hypnotic  influence;  therefore,  they  will  be  considered  here. 

POTASSII  BROMIDUM— U.  S.  P. 

(Potassium  Bromid;  KBr.) 

Potassium  bromid  is  a  salt  which  occurs  in  colorless,  or  white 
cubical  crystals  or  granules,  odorless,  with  a  pungent,  saline  taste; 
soluble  in  about  1.5  parts  of  water  and  in  180  parts  of  alcohol.  The 
dose  is  from  5-60  gr.  (0.3-4.0  gm.). 

Physiologic  Action. — The  chief  action  of  potassium  bromid  is  on 
the  nervous  system.  It  depresses  both  the  cerebrum  and  spinal  cord. 
The  drug  is  rapidly  absorbed  from  the  stomach,  it  having  been  found 
in  the  urine  fifteen  minutes  after  its  ingestion.  Its  elimination  is 
somewhat  slower  than  its  absorption,  and  there  is  a  tendency  for  the 
drug  to  accumulate  in  the  body.  The  continued  use  of  potassium 
bromid  is  followed  by  a  group  of  symptoms,  called  bromism,  chief 
among  which  are  anemia,  fetor  of  the  breath,  gastric  disturbance, 
mental  depression,  failure  of  memory,  abolition  of  sexual  appetite,  and 
muscular  weakness.  In  the  treatment  of  acute  poisoning,  eliminatives 
should  be  given  (diuretics  and  cathartics),  the  administration  of  the 
drug  should  be  withdrawn,  and  other  symptoms  treated  as  presented. 
No  fatal  case  of  poisoning  by  potassium  bromid  is  on  record. 

Therapeutics. — Perhaps  there  is  no  drug  which  will  control  the 


THE    BROMIDS.  145 

aervousness  due  solely  to  the  dread  of  the  dental  chair  better  than 
potassium  bromid.     The  drug  is  especially  indicated  in  union  , 
caused  by  fear  or  dread.    In  cases  of  highly  nervous  individuals  the 

drug  may  be  given  in  10  gr.  (0.6  gm.)  dose,  after  meals  and  well 
diluted,  one  day  previous  to  the  time  of  the  dental  operation.  On  ac- 
count of  the  nauseating  taste  the  drug  should  be  dissolved  in  some  of 
the  official  syrups.  The  compound  syrup  of  sarsaparilla  is  an  excel- 
lent vehicle. 

Potassium  bromid  is  one  of  the  best  drugs  to  control  the  con- 
vulsions of  epilepsy,  and  is  often  used  to  advantage  in  the  complications 
of  temporary  dentition.  The  drug  is  irritating  to  the  stomach,  and 
should  always  be  given  after  meals,  well  diluted.  It  may  be  com- 
bined with  the  antipyretic  drugs  with  excellent  results. 

Incompatibles. — Potassium  bromid  is  incompatible  with  acids 
and  acid  salts.  Certain  alkaloids  are  precipitated  from  neutral 
solutions  by  the  drug. 

SODII  BROMIDUM— U  .S.  P. 

(Sodium  Bromid;  XaBr.) 

Sodium  bromid  is  a  salt  which  occurs  in  colorless,  or  white, 
cubical  crystals  or  granules,  odorless,  and  of  a  saline,  bitter  taste; 
soluble  in  1.7  parts  of  water  and  in  12.5  parts  of  alcohol.  The  dose 
is  from  10-60  gr.  (0.6-4.0  gm.). 

Physiologic  Action  and  Therapeutics. — Sodium  bromid  closely 
resembles  potassium  bromid  in  its  action.  It  is  less  irritant  to  the 
stomach  and  less  depressant,  due  to  the  sodium  ion.  Because  of  this 
fact,  it  may  be  substituted  to  advantage  for  the  potassium  salt  in  cer- 
tain cases  in  which  a  bromid  is  indicated.  It  should  be  given  after 
meals,  well  diluted. 

Incompatibles. — The  same  as  protassium  bromid. 

AMMONII  BROMIDUM— U.  S.  P. 
(Ammonium  Bromid;  NH4Br.) 

Ammonium  bromid  is  a  salt  which  occurs  in  white  crystals  or  as 
a  yellowish-white  powder,  odorless,  and  having  a  disagreeable  salty 
taste;  soluble  in  1.2  parts  of  water  and  in  12.5  parts  of  alcohol.  The 
dose  is  from  10-60  gr.  (0.6-4.0  gm.). 

Physiologic  Action  and  Therapeutics. — Ammonium  bromid 
resembles  potassium  bromid  in  its  action.  Like  the  sodium  salt,  it 
is  less  irritant  to  the   stomach   and  less   depressant  to  the  nervous 


146  NARCOTICS. 

system.  It  may  be  substituted  for  potassium  bromid  in  all  cases 
calling  for  the  administration  of  a  bromid.  It  should  be  given  after 
meals,  well  diluted. 

Incompatibles. — The  same  as  potassium  bromid,  also  spirit  of 
nitrous  ether. 

NARCOTICS. 

Narcotics  are  agents  which  induce  stupor,  and  are  closely  related 
to  stimulants  in  that  the  first  effect  of  their  action  is  generally  that  of  an 
excitant  and  stimulant  to  the  higher  brain,  to  the  mind,  and  to  all  of  the 
bodily  functions;  this  stage  of  their  action  is  followed  by  profound 
sleep  characterized  by  increasing  stupor,  and,  if  the  dose  has  been 
sufficient,  the  second  stage  is  followed  by  a  third,  that  of  coma  and  in- 
sensibility (narcotism),  and  ultimate  death  due  to  paralysis  of  the 
centers  which  govern  respiration  and  other  functions  of  life.  The 
chief  narcotics  are: 

Opium  (and  Alkaloids).  Alcohol. 

Hyoscyamus.  Ether.* 

Scopola.  Chloroform.* 

Cannabis  Indica.  Chloral  Hydrate.* 
Tobacco. 

OPIUM— U.  S.  P. 

Opium  is  the  concrete  milky  exudation  {juice)  obtained  by  incising 
the  unripe  capsules  of  Papaver  somniferum,  a  poppy  plant  indigenous  to 
western  Asia  and  cultivated  in  Egypt,  Persia,  Asia  Minor,  and  other 
countries.  It  appears  in  irregular  cakes  or  lumps,  having  a  dark 
brown  color,  a  gummy  consistence,  a  peculiar  narcotic  odor,  and  a 
bitter  taste.  With  the  possible  exception  of  cinchona,  opium  contains 
more  alkaloids  than  any  other  drug.  The  chief  alkaloids,  in  the  order 
of  their  therapeutic  significance,  are  nwrphin,  codein,  narcein,  thebain, 
narcotin,  and  papaverin.  To  be  up  to  the  official  standard,  opium,  in 
its  normal  moist  condition,  should  yield  not  less  than  9  per  cent,  of 
crystallized  morphin.  The  dose  is  from  1/2-2  gr.  (0.03-0.13  gm.). 
The  official  preparations  are: 

Opii  Pulvis,  U.  S.  P.  (should  contain  not  less  than  12  nor  more 
than  12.5  per  cent,  of  Crystallized  Morphin).  Dose,  1/4-2  gr. 
(0.016-0. 13  gm.). 

Opium  Deodoratum,  U.  S.  P.  (Denarcotized  Opium,  12-12. 5 
per  cent,  of  Morphin).     Dose,  1/2-2  gr.  (0.03-0.13  gm.). 
Opium  Granulatum,  U.  S.  P.  (12-12. 5  per  cent,  of  Morphin). 
Dose,  1/2-2  gr.  (0.03-0.13  gm.) 


I  IPI1    M      \\l»    A  I  K  A  I  <)IDS.  147 

Piluls  Opii,   (J.  S.  P.   (1   gr.  0.06  gm.  of  Powdered  Opium  in 

each).     1'  pills. 

Extractum  Opii,  I  .  S.  P.  (20  per  cent,  of  Morphin).    Dose, 

1/4-1  gr.  (0.016-0.65  gm.). 

Tinctura   Opii,   U.   S.   P.   (Laudanum;    10   per   cent.).     D 

5-20  min.  (0.3-1 .3  c.c). 

Tinctura  Opii  Deodorati,  U.  S.  P.  (10  per  cent.).     Dose,  5-20 

min.   (0.3-1.3  c.c). 

Tinctura    Opii    Camphorata,    U.    S.   P.    (Paregoric;   contains 

Camphor,  Benzoic  Acid,  Oil  of  Anise,  and  Powdered  Opium; 

4  il.  dr.   (15.0  c.c.)    represents  about   1   gr.    (0.065   gm)    °f 

Opium).     Dose,  1/2-4  A-  dr.  (2.0-15.0  c.c). 

Tinctura  Ipecacuanhae  et  Opii,  U.  S.  P.     Dose,  5-15  min.  (0.3- 

1 .0  c.c). 

Acetum  Opii,  U.  S.  P.  (10  per  cent.).     Dose,  5-20  min.  (0.3- 

1.3  c.c). 

Yinum  Opii,  U.  S.  P.  (10  per  cent.).     Dose,  5-20  m.  (0.3-1.3 

c.c). 

Purvis  Ipecacuanhae  et  Opii,  U.  S.  P.  (Dover's  Powder;  contains 

10  per  cent,  of  Powdered  Opium;   10  per  cent,  of  Powdered 

Ipecac;  and  80  per  cent,  of  Sugar  of  Milk).     Dose,  5-10  gr. 

(0.3-0.65  gm.). 

Trochisci  Glycyrrhizae  et  Opii,  U.  S.  P.  (each  contains  1/12 

gr.-0.005  gm.  of  Powdered  Opium).     Dose,  1-5  tablets. 

Emplastrum  Opii,  U.  S.  P.  (6  per  cent,  of  Extract  of  Opium). 

Externally. 

Morphin  and  codein  are  the  chief  alkaloids  of  opium,  and  they 
represent  the  physiologic  activity  of  the  drug.  Both  are  official.  Mor- 
phin occurs  in  white  prismatic,  shining  crystals  or  fine  needles,  odorless, 
of  a  bitter  taste,  and  sparingly  soluble  in  water,  freely  so  in  alcohol. 
The  dose  is  from  1/8-1/ 2  gr.  (0.008-0.032  gm.). 

Codein  occurs  in  white  or  nearly  translucent  prisms,  or  a  crystal- 
line powder,  odorless,  and  having  a  faintly  bitter  taste;  soluble  in  88 
parts  of  water  and  in  1.6  parts  of  alcohol.  The  dose  is  from  1/2-2  gr. 
(0.03-0.13  gm.). 

The  salts  of  morphin  and  codein  are  much  more  soluble  than  the 
alkaloids  themselves,  and  these  are  generally  prescribed.  The  fol- 
lowing are  official: 

Morphinae  Acetas,  U.  S.  P.     Dose,  1/8-1/2  gr.  (0.008-0.032 

gm.). 

Morphinse    Hydrochloridum,     U.     S.    P.     Dose,   1/8-1/2    gr. 

(0.008-0.032  gm.). 

Morphin oe    Sulphas,    U.    S.    P.     Dose,    1/8-1/2    gr.     (0.008 

0.032   gm.). 


148  NARCOTICS. 

Pulvis  Morphinae  Compositus,  U.  S.  P.  (Tully's  Powder;  contains 
Licorice,  Camphor,  Calcium  Carbonate,  and  Morphin  Sulphate). 
Dose,  5-10  gr.  (0.3-0.65  gm.). 

Codeina?  Sulphas,  U.  S.  P.     Dose,  1/2-2  gr.  (0.03-0.13  gm.). 
Codeinas  Phosphas,  U.  S.  P.     Dose,  1/2-2  gr.  (0.03-0.13  gm.). 

Physiologic  Action. — Opium  is  a  narcotic  inducing  stupor,  and 
as  a  result  true  analgesic  and  hypnotic  effects  are  produced.  The 
dominant  action  being  due  to  the  morphin  which  it  contains.  The 
drug  acts  principally  upon  the  brain,  which  it  soon  depresses,  causing 
sleep.  When  the  dose  has  been  moderate,  a  stage  of  excitement  or 
exhilaration  generally  precedes  the  narcosis.  In  large  doses  opium 
is  a  powerful  respiratory  depressant,  and  in  fatal  cases  of  poisoning 
death  usually  results  from  paralysis  of  the  respiratory  centers. 

All  of  the  secretions,  except  the  perspiration,  are  diminished  by 
opium;  the  salivary  glands  are  especially  affected,  causing  great  dryness 
in  the  mouth  and  consequent  thirst;  digestion  is  also  impaired  and 
constipation  results. 

There  is  a  difference  of  opinion  in  regard  to  the  local  action  of 
morphin.  Stevens1  states  that  morphin,  applied  locally,  acts  as  a  direct 
depressant  to  the  sensory  nerve  filaments.  Many  pharmacologists 
claim  that  the  alkaloid  has  little  or  no  local  action,  and  that  to  produce 
its  effect  it  must  enter  the  circulation  and  be  carried  to  the  brain  where 
it  depresses  the  central  nervous  system. 

Opium  is  rapidly  absorbed  and  is  eliminated  chiefly  from  the 
viscera  of  the  stomach  and  intestines  (gastrointestinal  mucous  mem- 
brane) and  very  little  by  the  kidneys. 

Conditions  and  Drugs  Modifying  the  Action  of  Opium. — 
There  are  certain  symptoms,  diseases,  and  drugs  which  greatly  modify 
the  action  of  opium.  Patients  suffering  from  severe  pain,  such  as  in 
acute  alveolar  abscess,  neuralgia,  etc.,  or  patients  having  diabetes 
can  frequently  take  with  advantage  doses  which,  under  ordinary 
circumstances,  would  produce  profound  narcosis.  The  age  and  sex 
also  modify  the  action  of  opium.  Children  are  peculiarly  susceptible 
to  the  drug  on  account  of  their  sensitive  nervous  mechanism,  and, 
therefore,  smaller  doses  must  be  given  than  the  age  would  naturally 
indicate.  The  action  of  opium  is  more  pronounced  on  women  than 
on  men. 

Patients  rapidly  acquire  a  tolerance  of  the  drug  through  frequent 
repetition  of  the  dose,  so  that  habitues  can  often  take  large  quantities 
without  experiencing  the  usual  effects. 

'  Modern  Materia  Medica  and  Therapeutics. 


(ilMl'M    AND   ALKALOIDS.  149 

The  hypnotic  action  of  opium  is  enhanced  by  combining  it  with 
hvpnotic  drugs;  its  anodyne  influence  is  increased  by  belladonna  and 
cocain,  and  its  diaphoretic  effects  by  ipecac. 

Poisoning  and  Treatment. — It  is  the  acute  rather  than  the 
chronic  poisoning  by  opium  with  which  the  dentist  should  be  familiar. 
Unless  the  dose  is  very  large,  the  narcotic  symptoms  are  manifested  by 
three  distinct  stages.  The  first  is  excitement  or  exhilaration,  in  which 
the  imagination  is  stimulated  and  the  feelings  are  exhalted.  This  is 
soon  followed  by  the  second  stage  in  which  listlessness  and  drowsiness 
are  the  prominent  symptoms,  the  patient  finally  falling  into  a  deep 
sleep;  the  pulse  is  slow  and  full,  the  pupils  are  contracted  to  a  pin- 
point size,  the  respirations  are  slow  and  difficult,  the  muscles  are 
relaxed,  and  the  face  is  pale.  In  this  stage  it  is  still  possible  to  arouse 
the  patient  by  loud  noises,  shaking,  etc.  From  this  stage,  unless 
proper  treatment  be  given,  the  patient  gradually  passes  into  the  third, 
that  of  absolute  coma  and  insensibility — a  sleep  from  which  they  never 
awake,  death  finally  resulting  from  paralysis  of  the  respiratory  and 
other  life-centers. 

The  author  well  remembers  his  first  experience  in  poisoning  a  cat 
with  opium  in  the  pharmacy  course  of  instruction.  A  moderate  dose  of 
morphin  sulphate  was  hypodermically  administered.  In  a  few  minutes 
the  animal  imagined  it  had  caught  a  mouse  and  was  happy  playing 
with  it;  after  a  short  time,  it  became  drowsy  and  fell  asleep — here  the 
pupils  were  contracted,  respiration  was  slow  and  labored,  and  the 
muscles  completely  relaxed;  finally,  perhaps  a  half-hour  from  the  time 
the  first  symptoms  were  manifested,  the  cat  passed  into  that  comatose 
state  from  which  it  never  awoke. 

In  the  treatment  of  acute  opium  poisoning,  at  least  three  objects 
are  of  prime  importance:  to  eliminate  the  poison,  maintain  respiration, 
and  prevent  failure  of  circulation.  The  first  thing  to  do,  then,  is  to 
empty  the  stomach  either  by  means  of  the  stomach-pump  or  stimulating 
emetics,  as  zinc  sulphate  or  mustard  flour,  and  evacuate  the  bowels. 
Strong  black  coffee  may  be  given  by  the  mouth  or  bowel;  it  promotes 
wakefulness  and  stimulates  respiration.  Atropin  and  strychnin  may 
also  be  given.  The  best  chemic  antidote  is  potassium  permanganate; 
3-5  gr.  (0.2-0.3  gm.)  of  this  drug  should  be  dissolved  in  a  glassful  of 
water  and  given  at  once,  repeated  in  thirty  minutes,  if  necessary. 
Tannic  acid  has  also  been  recommended  as  a  chemic  antidote,  but 
neither  the  morphin  sulphate  nor  hydrochlorid  is  precipitated  by  it. 
Counterirritants,  slapping,  shouting  in  the  ear,  may  arouse  the  patient 
from  his  lethargy.     Continually  walking  the  patient  or  anything  to 


150  NARCOTICS. 

keep  him  awake  is  indicated.  When  the  third  stage  (narcotism)  is 
approaching,  artificial  respiration  by  Sylvester's  method  or  by  a  pump 
is  imperative. 

Therapeutics. — Opium,  or  its  alkaloids,  has  practically  but  one 
use  in  dental  practice  and  that  is  to  control  or  relieve  pain.  It  is  the 
greatest  analgesic  known  and  may  well  be  remembered  as  the  great 
"pain  killer."  In  allaying  the  severe  pain  of  fractures,  malignant 
growths,  and  acute  inflammations  of  serous  membranes  this  drug,  has  no 
rival.  Pain  of  moderate  intensity  may  often  be  allayed  by  the  ordinary 
antipyretic  and  hypnotic  drugs;  when  it  is  severe  and  excruciating 
and  the  cause  cannot  be  at  once  removed,  it  is  a  waste  of  time  to  ex- 
periment with  other  drugs  when  so  potent  an  agent  as  opium  is  obtain- 
able. In  neuralgias  and  other  forms  of  recurrent  pain  opium  or 
morphin  should  be  used  only  after  all  other  measures  have  failed,  and 
then  with  extreme  caution,  on  account  of  the  danger  of  forming  the 
opium  habit.  No  other  drug,  except  perhaps  alcohol,  is  more  enticing, 
and  its  continued  use  more  liable  to  form  the  drug-habit  than  opium. 
It  is  the  safest  for  a  dentist  never  to  write  a  prescription  for  the  drug. 
With  a  prescription  the  patient  may  be  relieved  from  the  pain  for  which 
the  remedy  was  prescribed,  but  subsequently  they  might  get  the 
prescription  refilled  on  the  least  provocation,  and  thus  the  habit  be 
innocently  formed.  Dover's  powder  is  a  common  and  valuable  remedy 
in  acute  coryza.  It  is  also  a  most  efficient  diaphoretic,  and  may  be 
used  in  dentistry  to  abort  an  acute  alveolar  abscess.  In  conditions 
where  the  pain  is  not  so  severe,  codein  sulphate  may  be  advantageously 
combined  with  other  hypnotic  drugs,  such  as  phenacetin,  etc. 

Morphin  has  been  added  to  various  formulas  for  devitalizing  the 
pulps  of  teeth.  But  as  the  drug  has  been  shown  to  possess  little  or  no 
local  action,  its  use  here  is  practically  valueless.  Cocain  being  far  pref- 
erable to  control  the  irritating  action  of  the  divitalizing  agent  (arsenic 
trioxid). 

Contraindications. — On  account  of  the  peculiar  susceptibility  of 
children  to  the  drug,  if  avoidable,  opium  should  not  be  given  under  five 
years  of  age.  One  minim  (0.06  c.c.)  of  tincture  of  opium  (laudanum) 
has  caused  the  death  of  a  child  one  day  old,  and  a  few  minims  of  cam- 
phorated tincture  of  opium  (paregoric)  has  proved  fatal  to  an  infant 
nine  months  old.  The  death  of  a  nursing  babe  is  even  reported  where 
the  mother  had  taken  a  medicinal  dose  of  laudanum.  The  drug  is,. 
therefore,  contraindicated  in  pregnancy  and  nursing  mothers. 


BYl  >scs  \MITS. 

HYOSCYAMUS     U.  S.  P. 
I  [enbane.) 

Hyoscyamus  is  the  dried  leaves  and  flowering  tops  of  Hyoscyamus 
niger,  a  plant  growing  in  Europe,  Asia,  and  North  America.  The 
specimen  should  be  collected  from  plants  of  the  second  year's  growth, 
and  should  yield,  when  assayed,  not  less  than  .08  per  cent,  of  alkaloids, 
of  which  there  are  two — hyoscyatnin  and  hyoscin.  Both  are  official,  the 
former  in  the  form  of  a  sulphate  (Hyoscyaminae  Sulphas,  U.  S.  P.)  and 
the  hydrobromid  (Hyoscyaminae  Hydrobromidum,  U.  S.  P.);  the  latter 
in  the  form  of  the  hydrobromid  (Hyoscina;  Hydrobromidum,  U.  S.  P.). 
The  dose  of  the  leaves  of  hyoscyamus  is  from  5-15  gr.  (0.3-1.0  gm). 
The  dose  of  the  salts  of  hyoscyamin  is  from  1/100-1/  50  gr.  (0.0006- 
0.0013  gm0-  The  dose  of  hyoscin  hydrobromid  is  from  1/150-1/80 
gr.  (0.0004-0.00085  gm.).  The  following  preparations  of  hyoscyamus 
are  official : 

Tinctura  Hyoscyami,  U.  S.  P.     Dose,  10-60  min.  (0.6-4.0  c.c). 
Fluidextractum  Hyoscyami,    U.  S.  P.     Dose,   5-15   min.    (0.3- 
1 .0  c.c). 
Extractum  Hyoscyami,  U.  S.  P.    Dose,  1/2-3  gr.  (0.03-0. 2  gm.). 

Physiologic  Action. — In  therapeutic  doses  hyoscyamus  resembles 
belladonna  in  its  action,  causing  dilatation  of  the  pupils,  checks  the 
salivary  secretions,  producing  dryness  of  the  throat,  and  quickens  the 
pulse  and  respiration.  Its  narcotic  action  upon  the  brain  is  some- 
what more  profound  than  that  of  belladonna.  The  consensus  of 
clinical  experience  seems  to  be,  also,  that  hyoscyamin  and  atropin 
closely  resemble  each  other  in  their  action;  with  hyoscin  the  action  is 
quite  different,  this  drug  being  a  distinct  hypnotic  in  that  it  depresses 
rather  than  stimulates  the  respiratory  center  (cerebrum). 

Therapeutics. — Neither  hyoscyamus  nor  its  alkaloids  arc  ex- 
tensively used  in  dentistry;  belladonna  and  atropin  answering  all  of  the 
purposes  for  which  the  former  drugs  could  be  employed.  In  neuralgia 
in  individuals  where  a  tonic  is  indicated  or  in  malarial  regions,  the 
following  remedy  made  into  12  pills  or  capsules,  one  given  before  meals, 
will  prove  beneficial: 

Quinin  Valerianate,  24  gr.  (1.5  gm.). 
Extract  of  Hyoscyamus,   4  gr.  (0.25  gm.). 
Kxtract  of  Cinchona,  8  gr.  (0.5  gm.). 

SCOPOLA— U.   S.  P. 

Scopola  is  the  dried  rhizome  of  Scopola  carniolica,  a  perennial 
plant    growing  in  southern  Europe.     It  is  closely  related  to  bella- 


I  5  2  NARCOTICS. 

donna  and  hyoscyamus.  It  contains  several  alkaloids,  the  principal 
one  being  scopolamin  which  is  chemically  identical  with  hyoscin,  and 
is  official  in  the  form  of  the  hydrobromid  (Scopolamine  Hydro- 
bromidum,  U.  S.  P.).  The  dose  of  scopola  is  about  1/2  gr.  (0.03  gm.). 
The  dose  of  the  alkaloidal  salt  is  from  1/150-1/ 80  gr.  (0.0004- 
0.00085  gm.) .     The  following  preparations  are  official : 

Fluidextractum  Scopolae,   U.   S.  P.     Dose,  1-3  min.  (0.06-0.2 

c.c). 

Extractum  Scopolae,  U.  S.  P.     Dose,  1/8-1/4  gr.  (0.008-0.016 

gm.). 

Physiologic  Action  and  Therapeutics. — Scopola  closely  re- 
sembles hyoscyamus  in  its  action  as  well  as  in  the  alkaloids  which 
it  contains,  and  may  be  used  for  practically  the  same  purposes.  Scopol- 
amin hydrobromid  and  morphin  sulphate  in  combination  have  been 
injected  hypodermically  previous  to  the  administration  of  general 
anesthetics  as  a  means  of  inducing  a  more  tranquil  anesthesia.  By 
this  means  there  is  said  to  be  the  absence  of  mental  excitement,  bron- 
chial irritation,  and  vomiting. 

CANNABIS  INDICA— U.   S.  P. 

(Indian  Hemp.) 

Cannabis  indica  is  the  dried  flowering  tops  of  Cannabis  sativa,  a 
pistillate  plant  growing  in  the  East  Indies.  It  contains  a  natural  resin 
called  cannabin,  and  the  specimen  of  the  drug  should  be  collected 
while  the  fruits  are  as  yet  undeveloped,  for  they  then  carry  the  whole 
of  their  resin.  The  dose  is  from  2-5  gr.  (0.13-0.3  gm.).  The  official 
preparations  are: 

Tinctura  Cannabis  Indicae,  U.  S.  P.     Dose,  5-20  min.  (0.3-1.3 

c.c). 

Fluidextractum    Cannabis   Indicae,    U.  S.  P.     Dose,   2-5   min. 

(o.  13-0.3  c.c). 

Extractum  Cannabis  Indicae,  U.  S.  P.     Dose,  1/8-1  gr.  (0.008- 

0.065  gm.). 

Physiologic  Action. — Internally  administered  in  therapeutic 
doses,  cannabis  indica  acts  as  a  mild  analgesic,  hypnotic,  and  sedative. 
At  first  there  is  a  marked  stimulation  of  cerebral  activities,  the  imagin- 
ation is  quickened  and  the  flow  of  ideas  heightened.  There  is  generally 
a  dreamy  state  accompanying  these  symptoms,  and  the  sensation  of 
pain  and  touch  are  blunted,  as  the  centers  governing  these  are  affected. 
The  excitement  is  finally  followed  by  sleep  which  may  last  for  several 


FABACUM.  153 

hours.  Although  alarming  symptoms  often  follow  large  doses  of  the 
drug,  death  directly  attributable  to  it  has  not  been  reported. 

Therapeutics. — Cannabis  indica  is  employed  for  its  mild  anal- 
gesic action  in  certain  forms  of  neuralgia,  especially  migraine  and 
headache.     It  is  extensively  employed  as  a  hypnotic  in  melancholia. 

The  extract  should  be  given  in  pill  or  capsule,  the  tincture  and 
fluid  extract  in  alcoholic  menstruum  on  account  of  the  resinous  con- 
stituent (cannabin)  being  precipitated  by  aqueous  solutions.  The 
drug  is  not  employed  for  many  of  the  disorders  for  which  it  was  for- 
merly used. 


TABACUM— Unofficial. 
(Tobacco.) 

Tobacco  is  the  commercial  dried  leaves  of  Xicotiana  tabacum,  an 
annual  plant  indigenous  to  tropical  America,  but  cultivated  in  several 
parts  of  the  world,  especially  in  Virginia  and  Cuba.  It  contains  a 
very  poisonous,  volatile,  oily  liquid  alkaloid,  called  nicotin.  The 
quantity  of  the  alkaloid  varies  greatly  in  the  different  specimens, 
depending  largely  upon  the  climate  and  soil  of  the  various  countries 
in  which  it  is  raised.  Cuba  is  supposed  to  produce  about  the  best 
specimen  of  tobacco. 

Physiologic  Action  and  Therapeutics. — Tobacco  is  a  marked 
depressant  nauseant,  it  produces  emesis  by  irritation  as  well  as  by 
systemic  action.  Its  continued  use  by  smoking  or  chewing  it  to  excess, 
produces  granular  inflammation  of  the  mucous  membrane  of  the 
mouth  and  pharynx,  atrophy  of  the  retina,  dyspepsia,  lowered  sexual 
vitality,  sudden  faints,  nervous  depression,  and  cardiac  irritability. 
Used  by  the  young,  it  hinders  the  development  of  the  brain,  and  inter- 
feres with  metabolism  in  general  (Osier).  It  is  claimed  to  produce 
cancer  of  the  lips  and  tongue,  blunting  of  the  moral  sense,  mental 
aberration,  and  even  insanity.  The  so-called  ''tobacco  heart"  induces 
many  forms  of  nervous,  painful,  and  oppressed  cardiac  action,  depend- 
ing upon  the  age,  quantity  used,  and  other  conditions. 

Xicotin  is  one  of  the  most  deadly  poisons  known.  The  author 
remembers  poisoning  a  cat  with  this  agent  in  the  pharmacy  school. 
The  animal  at  once  became  greatly  excited,  then  there  was  a  wild 
stare,  a  deep  sigh,  and  sudden  death  within  three  minutes  after  the 
ingestion  of  the  drug.  The  claim  that  nicotin  enters  the  body  from 
smoking  tobacco  is  without  foundation,  as  the  liquid  alkaloid  is  vola- 
tile and  the  heat  breaks  it  up  into  other  compounds  far  less  poisonous. 


154  STIMULANTS. 

Chewing  tobacco  is  supposed  to  allay  toothache  by  many  laymen. 
The  claim  is  not  justified  from  the  physiologic  action  of  the  drug. 
Tobacco  is  not  used  therapeutically  in  dentistry. 

STIMULANTS. 

Stimulants  are  agents  which  increase  the  activity  of  life  processes 
or  functions.  When  the  term  stimulant  is  applied  to  medicinal  agents 
it  is  used  in  various  senses  and  is  generally  accompanied  by  such 
adjectives  as  cardiac,  respiratory,  gastric,  restorative,  etc.,  to  indicate 
the  various  organs  and  processes  of  the  body  stimulated  by  the  ad- 
ministration or  application  of  the  drug. 

CARDIAC  STIMULANTS. 

These  are  agents  which  increase  the  functional  activity  or  the  effi- 
ciency of  the  heart's  action.     The  chief  cardiac  stimulants  are: 

Nux  Vomica  (Strychnin).  Digitalis. 

Alcohol.  The  Nitrites. 

Ammonia.  Camphor. 

Caflein.  y 

NUX  VOMICA— U.  S.  P. 

Nux  vomica  is  the  dried  ripe  seeds  of  Strychnos  nux  vomica,  a 
small  tree  growing  in  the  East  Indies.  The  drug  contains  two 
important  alkaloids — strychnin  and  brucin,  the  former  being  in  excess 
and  fully  represents  the  action  of  the  crude  drug  which  should  contain, 
when  assayed,  not  less  than  1.25  per  cent,  of  crystallized  strychnin. 
Brucin  resembles  strychnin  in  its  action,  but  is  much  less  powerful. 
The  dose  of  powdered  nux  vomica  is  from  1-5  gr.  (0.06-0.3  gm0- 
The  following  preparations  are 'official: 

Tinctura  Nucis  Vomicae,  U.  S.  P.     Dose,  5-20  min.  (0.3-1.3 
c.c). 

Fluidextractum    Nucis    Vomica;,    U.    S.   P.      Dose,    1-5   min. 
(0.06-0.3  c.c). 

Extractum  Nucis  Vomicae,  U.  S.  P.     Dose,  1/8-1/2  gr.  (0.008- 
0.03  gm.). 
As  has  been  stated,  strychnin  fully  represents  the  action  of  nux 
vomica.     This  alkaloid  is  official. 

STRYCHNINA— U.  S.  P. 

It  occurs  as  colorless  crystals  or  a  white  crystalline  powder, 
odorless,  and  having  an  intensely  bitter  taste;  sparingly  soluble  in 
water.     Two  salts  of  strychnin  are  official,  the  sulphate  (Strychninse 


M\    VOMICA  AND   STRYCHNIN.  1 55 

Sulpha-,  r.  S.  P.)  and  the  nitrate  Strychninae  Nitras,  U.  S.  P.  .  Both 
in  appearance  resemble  the  alkaloid  itself ,  but  arc  much  more  soluble 
in   water.     The  dose  of  strychnin  or  of  cither  of  its  salts  is  from 

1/C10-1/20  gr.   (o.oor-0.00^  gm.). 

Strychnin  is  a  constituent  of  the  following  official  preparations: 

Glycerite  of  the  Phosphates  of  Iron,  Quinin,  and  Strychnin. 
Syrup  of  the  Phosphates  of  Iron,  Quinin,  and  Strychnin. 
Compound  Syrup  of  Hypophosphites. 
Compound  Laxative  Pills. 

Klixir  Iron,  Quinin,  and  Strychnin,  X.  F. 

Physiologic  Action. — Strychnin  is  a  true  cardiac  stimulant, 
the  pulse  becoming  stronger  and  more  rapid  under  its  influence  as  a 
result  of  its  action  upon  the  heart  and  vasomotor  center.  The  drug 
also  acts  as  a  powerful  respiratory  stimulant,  the  movements  of  respira- 
tion becoming  deepened  and  quickened.  The  chief  action  of  strychnin 
is  upon  the  nervous  system.  Here  it  acts  as  a  powerful  stimulant  to  the 
spinal  cord,  especially  the  centers  governing  the  movements  of  the 
body.  The  most  marked  effect  of  the  drug,  in  toxic  doses,  is  increased 
reflex  irritability  of  the  spinal  cord,  which  is  shown  most  conspicuously 
by  the  production  of  muscular  rigidity.  Nux  vomica  or  strychnin, 
in  small  doses,  strengthens  the  muscular  movements  of  the  stomach 
and  increases  the  flow  of  gastric  secretions.  It  therefore  acts  as  a. 
stomachic.     The  drug  is  eliminated  principally  through  the  kidneys. 

Poisoning  and  Treatment. — If  the  dose  of  strychnin  is  within 
therapeutic  limits,  yet  sufficient  to  produce  slight  toxic  effects,  the 
first  symptom  is  likely  to  be  a  feeling  of  uneasiness  with  heightened 
reflex  irritability,  and  this  may  be  followed  by  muscular  twitching 
in  some  part  of  the  body.  With  larger  doses,  spinal  convulsions 
result  from  the  slightest  external  irritation,  causing  the  patient  to 
rest  on  his  head  and  feet  (opisthotonos);  the  flexor  muscles  are  over- 
come by  the  extensors,  and  the  feet  are  curved  inward.  The  convul- 
sions for  the  most  part  are  intermittent;  during  the  intermission  there 
is  complete  muscular  relaxation.  During  the  attack  the  contraction 
of  the  facial  muscles  causes  the  patient  to  grin  in  a  ghastly  manner,  but 
the  muscles  of  the  jaws  are  unaffected  until  toward  the  last.  This 
latter  diagnostic  sign  should  be  remembered,  as  strychnin  poisoning 
may  become  confused  with  tetanus  on  account  of  the  rigidity  of  the 
muscles  during  the  convulsive  attacks.  In  tetanus  the  muscles  of  the 
jaw  are  very  early  implicated.  Other  diagnostic  marks  of  tetanus, 
as  contrasted  with  it,  are  slower  development  of  the  symptoms  and 
the  continuous  muscular  rigidity.      There  is  never  complete  muscular 


156  STIMULANTS. 

relaxation  even  in  the  intermission  of  the  spasms  as  there  is  in  strychnin 
poisoning. 

The  number  of  convulsive  seizures  varies  in  different  instances,  but 
generally  three  or  four  are  fatal;  the  patient  succumbing  to  asphyxia 
and  exhaustion.  In  the  treatment  of  strychnin  poisoning,  if  the  patient 
is  seen  early  enough,  emetics,  particularly  apomorphin  hydrochlorid 
(1/10  gr.-0.006  gm.)  hypodermically,  should  be  given,  followed  by 
washing  out  the  stomach.  If  violent  convulsions  already  are  present, 
evacuation  of  the  stomach,  as  a  rule,  is  contraindicated,  as  either 
emetics  or  the  stomach-pump  would  provoke  further  attacks.  Inhala- 
tions of  chloroform  or  amyl  nitrite  will  control  the  spasms.  As  a 
chemic  antidote  tannic  acid  in  solution  may  be  administered.  Prob- 
ably the  best  physiologic  antidotes  are  potassium  bromid  (1-2  dr. — 4.0 
-8.0  gm.)  and  chloral  hydrate  (20  gr. — 1.3  gm.);  when  the  patient  is 
unable  to  swallow,  the  latter  drug  (1  dr.-4.o  gm.)  may  be  given  in  an 
enema  (per  rectum).  These  agents  depress  the  nerve  centers  stimu- 
lated by  the  strychnin.  Since  the  slightest  external  stimulus  will 
provoke  convulsions,  the  patient  should  be  disturbed  as  little  as  possible. 
Therapeutics. — -Nux  vomica  or  strychnin  is  used  chiefly  as  a 
cardiac  stimulant,  a  respiratory  stimulant,  a  motorexcitant,  and  a 
stomachic.  Strychnin  sulphate,  in  soluble  tablet  form  of  proper 
therapeutic  dose  (1/60  gr.-o.ooi  gm.),  should  be  in  every  dental 
office.  It  being  both  a  cardiac  and  respiratory  stimulant  makes  it  a 
valuable  remedy  in  cases  of  poisoning  by  drugs  which  depress  the 
cardiac  and  respiratory  center.  In  poisoning  by  cocain,  opium,  chloral 
hydrate,  aconite,  ether,  chloroform,  or  ethyl  chlorid,  it  should  be  given 
hypodermically  in  full  doses  and  repeated,  if  necessary  in  fifteen  min- 
utes. In  neuralgia  due  to  an  atonic  condition,  strychnin  is  indicated. 
Here  it  may  be  given  in  either  the  elixir,  syrup,  or  glycerite  of  the 
phosphates  of  iron,  quinin,  and  strychnin. 

Incompatibles. — Strychnin  is  incompatible  with  tannic  acid, 
alkalies,  and  the  salts  of  the  halogen  elements  (CI,  I,  and  Br.). 

ALCOHOL— U.  S.  P. 

(Ethyl  Alcohol;  C2H5OH.) 

Ethyl  alcohol  is  obtained  by  the  distillation  of  fermented  sac- 
characeous  substances.  To  be  up  to  the  official  standard  it  must 
contain  92.3  per  cent,  by  weight  of  absolute  ethyl  alcohol.  It  occurs 
as  a  colorless,  transparent,  mobile,  and  volatile  liquid,  having  a  pungent 
odor,  and  a  burning  taste;  miscible  with  water,  ether,  and  chloroform 


ALCOHOL.  157 

in  all  proportions.     It  is  inflammable  and  burns  with  a  bluish,  non- 
luminous  flame. 

The  following  preparations  are  official: 

Alcohol  Absolutum,  U.  S.  P.  (99  per  cent.  Alcohol). 

Alcohol  Dilutum,  U.  S.  P.  (41 .5  per  cent,  by  weight  of  Absolute 

Alcohol). 

SpiritUS   Frumcnti,   U.   S.  P.   (Whisky;  37  to  47.5   per  cent. 

Alcohol,  distilled  from  fermented  grain). 

Spiritus  Vini   Gallici,   U.   S.   P.    (Brandy;   39  to  47   per  cent. 

Alcohol;  distilled  from  fermented  grapes). 

Spiritus  Juniperi  Compositus,  U.  S.  P.  (equivalent  to  Gin;  about 

60  per  cent.  Alcohol). 

Vinum  Album,  U.  S.  P.  (White  Wine;  7  to  12  per  cent.  Alcohol). 

Yinum  Rubrum,  U.  S.  P.  (Red  Wine;  7  to  12  percent.  Alcohol). 

The  official  wines  are  made  by  fermentation  of  pure  grape  juice. 
The  following  unofficial  preparations  contain  alcohol : 

Rectified  Spirit  (85  per  cent,  by  weight  of  Absolute  Alcohol). 
Proof  Spirit  (49  per  cent,  by  weight  of  Absolute  Alcohol, 
Volatile  Oil,  and  other  foreign  material). 

Gin  (42  per  cent,  by  weight  of  Absolute  Alcohol,  distilled  in 
Holland  from  rye  or  barley,  and  flavored  with  juniper  berries 
or  hops). 

Malted  Liquors  (Beer,  Ale,  and  Porter)  are  prepared  by  ferment- 
ing malted  grain  with  hops  and  adding  other  bitters.  Beer 
contains  2  to  3  per  cent,  of  Alcohol;  ale  and  porter,  from  4  to  6 
per  cent.,  besides  carbonic  and  lactic  acids,  malt  extract, 
various  aromatics,  and  certain  salts  of  sodium  and  potassium. 

Physiologic  Action. — There  is  much  diversion  of  opinion  re- 
garding the  physiologic  action  and  uses  of  alcohol.  Applied  to  the  skin, 
it  extracts  water  from  the  tissues  and  acts  as  a  detergent  and  antiseptic. 
On  the  mucous  membrane  it  extracts  water  with  greater  rapidity, 
coagulates  albumin,  and  causes  a  whitened  and  corrugated  surface. 
The  gastric  functions,  as  well  as  the  flow  of  saliva,  are  reflexly  stimu- 
lated by  its  local  action  in  the  mouth. 

Internally  administered,  alcohol  reflexly  and  rapidly  stimulates  the 
heart  before  absorption  can  take  place,  the  effect  upon  the  circulation 
persisting  after  the  absorption  of  the  drug.  It  depresses  the  vasocon- 
strictors; thus  arterial  tension  is  raised,  though  the  arterioles  are  dilated. 
Toxic  doses  depress  the  heart's  action,  and  still  further  dilate  the 
peripheral  blood-vessels.  This  action  of  alcohol,  in  causing  the  heart 
to  beat  stronger  and  faster,  at  the  same  time  dilating  the  blood-vessels 
— especially  those  of  the  peripheries — renders  the  drug  one  of  the  most 


158  STIMULANTS. 

valuable  diffusible  stimulants  (Butler).  The  dominant  action  of 
alcohol  is  on  the  nervous  system.  It  first  stimulates  and  then  paralyzes 
all  parts  of  the  nervous  system. 

Poisoning  and  Treatment. — The  poisonous  action  of  alcohol 
may  be  discussed  as  acute  and  chronic  alcoholism. 

Acute  Intoxication. — The  ingestion  of  large  quantities  of  alcohol 
produce  certain  characteristic  symptoms:  Flushing  of  the  face,  mental 
excitement,  a  quickened  pulse  and  respiration;  in  a  short  time  the 
speech  becomes  incoherent,  the  pupils  are  dilated,  then  follows  de- 
lirium, loss  of  coordination,  subnormal  temperature,  vomiting,  loss  of 
ability  to  control  the  acts  of  toilet,  and,  finally,  stupor  and  coma.  If 
the  dose  has  not  been  too  large,  recovery  follows  in  a  day  or  two. 

Stevens1  emphasizes  the  care  to  be  taken  in  order  to  distinguish 
acute  alcoholism  from  uremia,  opium  poisoning,  and  apoplexy.  The 
urinous  odor  of  the  breath,  the  small  pupils,  and  the  presence  of 
albumin  in  the  urine  will  serve  to  distinguish  uremia.  The  small 
pupils,  slow  and  labored  respiration,  and  slow  and  full  pulse  will 
point  to  opium  poisoning.  The  unequal  pupils,  hemiplegia,  and 
high  temperature  will  indicate  apoplexy.  In  the  treatment  of  acute 
alcoholism  the  stomach  should  be  emptied  of  all  unabsorbed  alcohol 
by  the  stomach-pump,  a  stimulating  emetic  (mustard  flour),  or  the 
hypodermic  injection  of  apomorphin  (1/10  gr.-0.006  gm.).  Cautious 
inhalations  of  ammonia  should  be  given,  together  with  the  internal 
administration  of  black  coffee.  The  patient  should  be  made  to  per- 
spire freely  by  the  application  of  external  heat  (warm  blankets,  etc.), 
and  if  there  is  danger  of  collapse,  strychnin  sulphate  (1/30  gr.-0.002 
gm.)  should  be  hypodermically  administered  and  artificial  respiration 
practised. 

Chronic  alcoholism  is  generally  the  result  of  the  continuous  and 
excessive  use  of  alcohol,  and  is  characterized  by  disturbed  sleep,  fine 
tremor,  mental  impairment,  gastric  irritation,  injection  of  the  eyes, 
redness  of  the  nose  and  cheeks,  due  to  the  permanent  dilatation  of  the 
capillaries.  A  frequent  complication  of  chronic  alcoholism  is  delirium 
tremens.  This  condition  is  manifested  by  great  mental  excitement, 
insomnia,  incoherent  speech,  tremors,  and  terrifying  hallucinations  of 
sight  and  hearing.  In  favorable  cases  recovery  follows  in  a  few  days, 
but  frequently  symptoms  of  typhoid  and  pneumonia  develop,  and  the 
attack  ends  in  death.  In  the  treatment  of  delirium  tremens  the  main 
indications,  according  to  Butler,2  are: 

'Modem  Materia  Medica  and  Therapeutics. 

2  Text-Book  of  Materia  Medica,  Therapeutics  and  Pharmacology. 


ALCOHOL.  159 

i.  Elimination  by  diaphoresis,  catharsis,  diuresis,  warm  baths,  etc. 

2.  Support. — Some  alcohol  may  be-  necessary.  Easily  digested 
food.     Enema ta.  if  necessary. 

3.  Quiet. — Hypnotics:  opium,  chloral  hydrate,  the  bromids. 

In  the  treatment  of  chronic  alcoholism  it  is  necessary  to  consider 
the  character  of  the  individual  affected.  Butler  states  that  a  thoughtful 
and  extended  experience  with  dipsomaniacs  will  convince  most  observers 
that  the  vast  majority  of  them  suffer  from  a  disease  possessing  usually 
a  distinct  and  traceable  etiology,  and  resulting  from  either  inherited 
or  acquired  neurosis.  It  is  a  condition  akin  to  epilepsy;  the  treatment. 
therefore,  turns  on  the  discovery  of  the  conditions  preliminary  to  the 
drinking  period  and  the  determination  whether  this  can  be  prevented 
by  dietetic  and  therapeutic  measures,  as  is  done  in  cases  of  epilepsy. 

The  medicinal  agents  employed  are  strychnin,  atropin,  small  doses 
of  such  alteratives  as  arsenic,  potassium  iodid,  and  mercury,  while 
phosphorus  and  other  restoratives  and  tonics  will  prove  efficacious. 

Therapeutics. — Alcohol  is  extensively  used  locally  in  dentistry 
as  a  dehydrator,  detergent,  and  antiseptic.  Its  action  upon  bacteria 
is  no  doubt  due  to  its  power  of  abstracting  water  and  of  coagulating 
albumin.  According  to  the  experiments  of  pharmacologists,  the  most 
effective  dilutions  of  alcohol  against  the  strongly  resisting  (nonsporing) 
bacteria,  such  as  the  pus  organisms,  are  those  containing  from  60  to 
70  per  cent,  by  volume. 

For  spraying  the  mouth  previous  to  performing  any  dental  oper- 
ation, the  author  is  very  partial  to  cinnamon  water  to  which  from 
2-5  per  cent,  of  alcohol  has  been  added.  It  should  be  remembered  that 
alcohol  is  less  valuable  as  a  disinfectant  than  as  an  antiseptic  and  as  a 
vehicle  for  stronger  agents  of  this  class;  therefore,  from  10  to  25  per 
cent,  alcohol  makes  an  excellent  addition  to  aqueous  antiseptic  solu- 
tions. Absolute  alcohol  is  frequently  added  to  tooth-pastes  for  its 
antiseptic  and  solvent  power.  The  drug  is  used  as  a  styptic  to  check 
capillary  oozing,  and  a  very  efficient  means  of  reducing  temperature 
in  fever  is  to  bathe  the  skin  with  alcohol;  the  method  is  also  employed 
to  check  excessive  sweating.  Alcohol  is  a  positive  antidote  for  phenol, 
and  whenever  the  latter  agent  is  being  used  about  the  mouth,  it  should 
be  in  a  convenient  place  to  neutralize  the  caustic  action  of  phenol,  should 
the  latter  accidentally  get  on  the  soft  tissues  of  the  mouth.  Alcohol 
is  employed  internally  as  a  diffusible  circulatory  stimulant,  a  stomachic, 
a  food,  and  a  chemic  antidote  for  phenol.  In  all  forms  of  sudden 
heart-failure,  as  in  syncope,  shock,  snake-bite,  etc.,  it  is  an  invaluable 
stimulant.     Whisky   or   brandy  should  be  in  every  dental    office    to 


l6o  STIMULANTS. 

be  used  as  a  cardiac  stimulant  in  cases  of  cocain  poisoning  or  other 
conditions  which  depress  the  heart. 

AMMONIA. 

(NH3.) 

Ammonia  is  obtained  as  a  by-product  in  the  manufacture  of 
coal-gas.  It  occurs  as  a  colorless  gas,  having  a  very  penetrating  odor 
and  an  acrid  taste.  It  is  chemically  soluble  in  water,  and  in  chemistry 
it  is  considered  a  hypothetical  metal,  as  it  acts  like  a  base  in  uniting  with 
acids  to  form  salts.     The  following  preparations  are  official: 

Aqua  Ammoniae  Fortior,  U.  S.  P.  (Stronger  Ammonia  Water; 

28  per  cent,  by  weight  of  the  Gas). 

Aqua  Ammonias,  U.  S.  P.  (Ammonia  Water;  10  per  cent,  by 

weight  of  the  Gas). 

Spiritus  Ammoniae,  U.  S.  P.   (Spirit  of  Ammonia;  10  per  cent. 

by  weight  of  the  Gas). 

Spiritus  Ammonias  Aromaticus,  U.   S.  P.  (Aromatic  Spirit  of 

Ammonia;    contains    Ammonium    Carbonate,    34;    Ammonia 

Water,  90;  Oil  of  Nutmeg,  1;  Oil  of  Lemon,  10;  Oil  of  Lavender 

Flowers,  1;  Alcohol,  700;  Water  to  make  1,000).     Dose,  1/4  to  1 

fl.  dr.  (1 .0-4.0  c.c). 

Linimentum  Ammoniae,  U.  S.  P.     Externally. 

Physiologic  Action. — Ammonia  has  a  decidedly  irritant  local 
action,  and  in  concentrated  solution  it  speedily  produces  vesication. 
The  drug  has  the  decided  advantage  of  being  a  gas  which  permits 
of  inhalation,  and  its  irritant  action  upon  the  mucous  membrane  of 
the  respiratory  passages  reflexly  stimulates  the  cardiac  and  respira- 
tory centers;  both  the  strength  and  rapidity  of  the  pulse  and  the  depth 
and  rapidity  of  the  respirations  are  markedly  increased.  Given  in 
weak  solutions,  the  drug  stimulates  the  flow  of  gastric  juice,  its  action 
here  resembling  other  alkalies.  The  gas  acts  upon  the  nervous  sys- 
tem by  stimulating  the  motor  centers  of  the  spinal  cord,  and  thus  re- 
flex activity  is  increased. 

Poisoning  and  Treatment. — In  toxic  doses  preparations  of 
ammonia  are  powerful  corrosive  poisons.  The  characteristic  symp- 
toms are  severe  burning  pain  in  the  fauces,  esophagus,  and  stomach, 
with  intense  gastroenteritis.  The  violent  irritation  of  the  throat  some- 
times causes  edema  of  the  larynx,  resulting  in  almost  immediate  death 
from  asphyxia.  In  the  treatment  of  ammonia  poisoning  the  drug  should 
be  neutralized  by  some  weak  acid,  like  vinegar.  This  should  be  followed 
by  demulcent  drinks,  opium  being  indicated  for  the  relief  of  pain. 


ammiimi    CA&BONAS.  161 

Therapeutics.  -The  chief  use  of  ammonia  in  dental  thera- 
peutics is  as  a  cardiac-  and  respiratory  stimulant.  The  drug  acts 
quickly,  and  is  an  invaluable  remedy  in  syncope,  collapse,  and  other 
forms  of  sudden  heart  failure.  When  it  is  desired  to  give  the  drug  by 
inhalation,  as  can  easily  be  done  on  account  of  the  volatility  of  the 
gas  from  its  solutions,  it  is  best  to  select  the  spirit  of  ammonia  or 
ammonia  water  as  the  preparation  to  use.  For  internal  adminis- 
tration the  aromatic  spirit  of  ammonia  should  be  selected  and  given 
well  diluted. 

The  liniment  of  ammonia  is  a  popular  counterirritant  remedy 
in  chronic  rheumatism,  joint  affections,  and  chilblains. 

Incompatibles. — Ammonia  is  incompatible  with  all  acids, 
chloral  hydrate,  and  alkaloids.  With  ferric  salts  it  forms  ferric 
hydroxid,  which  is  an  antidote  for  arsenic.  With  formaldehyd  it 
forms  urotropin. 

AMMONII  CARBONAS— U.   S.   P. 

(Ammonium  Carbonate;  NH4HC03.NH4NH2C02.) 

The  official  ammonium  carbonate  is  really  a  mixture  of  ammo- 
nium acid  carbonate  and  ammonium  carbamate.  It  occurs  in  white, 
internally  translucent,  crystalline  masses,  having  an  extremely  pungent 
odor,  and  an  acrid  taste;  soluble  in  4  parts  of  water.  The  dose  is  from 
5-10  gr.  (0.3-0.6  gm.). 

Physiologic  Action  and  Therapeutics. — This  drug  is  a  cardiac 
and  respiratory  stimulant,  due  to  the  ammonia  gas  which  is  con- 
stantly liberated.  It  is  also  a  stimulating  expectorant.  It  enters  into 
the  composition  of  aromatic  spirit  of  ammonia,  which  preparation  is 
extensively  used  in  dental  therapeutics. 

CAFFEINA— U.   S.  P. 
(Caffein;  C8HION402.H20.) 

Caffein  is  an  alkaloid  obtained  from  the  leaves  of  Thea  sinensis 
(tea),  or  from  the  seeds  of  Coffca  arabica  (coffee).  It  occurs  in  fine, 
colorless,  silky  crystals,  without  odor,  and  having  a  bitter  taste; 
soluble  in  about  46  parts  of  cold"  water.  The  dose  is  from  2-5  gr. 
(0.13-0.3  gm.).     The  following  preparations  are  official: 

Caffeina  Citrata,   U.   S.  P.    (Caffein   Citrate).     Dose,   2-5  gr. 

(0.13-0.3  gm.). 

Caffeina  Citrata  Effervescens,  U.  S.  P.     Dose,  1-2  dr.  (4.0-8.0 

gm.). 


1 62  STIMULANTS. 

Physiologic  Action. — Caffein  is  a  powerful  cardiac  and  respi- 
ratory stimulant.  Its  action  upon  the  circulatory  system  results  in 
high  blood-pressure  and  increased  frequency  of  the  pulse,  due  in  part 
to  its  direct  influence  upon  the  heart  and  its  stimulating  action  upon 
the  vasomotor  centers.  The  brain  seems  to  be  especially  suscep- 
tible to  the  influence  of  caffein,  small  doses  sharpen  the  intellect  and 
produce  wakefulness.  The  drug  also  acts  as  a  diuretic,  stimulating 
the  secreting  structure  of  the  kidneys,  and  is  quickly  eliminated  through 
these  organs. 

Therapeutics. — Caffein  is  an  entirely  safe  drug  to  be  used  in 
large  dose,  hence  it  is  one  of  the  best  stimulants  to  employ  in  poisoning 
by  narcotic  drugs,  like  cocain,  opium,  etc.  Caffein  citrate  is  the 
preparation  generally  used  because  it  is  more  soluble  than  caffein. 
Strong  black  coffee  is  also  used. 

The  drug  is  a  constituent  of  compound  acetanilid  powder.  Its 
action  overcomes  the  depressant  effect  of  acetanilid  upon  the  heart. 
It  may  also  be  combined  with  phenacetin  or  a  bromid  and  used  with 
excellent  results  in  migraine  and  nervous  headache. 

DIGITALIS— U.  S.  P. 

(Foxglove.) 
Digitalis  is  the  dried  leaves  of  Digitalis  purpurea,  a  biennial 
plant  growing  in  central  and  southern  Europe.  It  contains  several 
principles,  all  of  which  are  glucosidal  in  character,  the  most  important 
being  digitalin,  digitoxin,  digitalein,  digitonin,  and  digitin.  The  first 
two  represent  more  or  less  imperfectly  the  action  of  digitalis  upon  the  • 
heart,  and  since  both  are  freely  soluble  in  alcohol  and  practically 
insoluble  in  water,  it  will  at  once  be  observed  that  the  most  active 
principles  of  the  drug  are  contained  in  the  tincture,  fluid  extract,  and 
extract,  and  the  least  active  in  the  infusion;  all  of  which  preparations 
of  digitalis  are  official: 

Tinctura  Digitalis,  U.  S.  P.     Dose,  5-20  min.  (0.3-1.3  c.c). 

Fluidextractum  Digitalis,   U.   S.  P.     Dose,  1-2  min.  (0.06- 

o.  12  c.c). 

Extractum  Digitalis,  U.  S.  P.     Dose,  1/6-1  / '2  gr.  (0.01-0.03 

gm.). 

Infusum  Digitalis,  U.  S.  P.     Dose,  1-4  fl.  dr.  (4.0-15.0  c.c). 

Physiologic  Action. — Digitalis  is  a  powerful  cardiac  stimulant. 
It  does  not  increase  the  rapidity  of  the  heart's  action;  it  rather  slows 
the  pulsations  and  raises  the  blood-pressure,  but  in  spite  of  this  the 


DIGITALIS.  163 

efficiency  of  the  contraction  is  increased  and  the  pulse  improved  in 
character.  In  therapeutic  doses  the  drug  has  practically  no  effect 
except  on  the  circulation.  The  slowing  of  the  pulse  results  from  a 
prolongation  of  the  diastole,  and  this  in  turn  is  due  to  stimulation  of 
the  vagi.  Tl\e  increased  blood-pressure  is  due  to  the  twofold  action 
of  the  drug,  that  of  securing  efficiency  by  the  direct  action  upon  the 
heart,  and  to  the  contraction  of  the  arterioles,  which  results  indirectly 
from  the  stimulation  of  the  vasomotor  center,  and  directly  from  the 
action  on  the  vessel-walls.  In  cases  of  low  arterial  pressure,  when 
the  urine  is  scanty,  digitalis  acts  as  a  diuretic. 

Poisoning  and  Treatment. — Digitalis  is  more  rapidly  absorbed 
than  eliminated;  because  of  this,  cumulative  action  may  follow  the  pro- 
longed use  of  the  drug  even  in  therapeutic  doses.  Toxic  symptoms 
may  result  from  this  source  or  from  the  ingestion  of  a  single  poisonous 
dose.  Poisoning  is  characterized  by  gastrointestinal  disturbances, 
abdominal  pains,  vomiting,  and  purging;  the  pulse  is  slowed,  respira- 
tion feeble,  pupils  dilated,  headache,  delirium,  and  stupor.  If  a 
fatality  results,  it  is  generally  from  ten  to  forty-eight  hours  after  the 
ingestion  of  the  drug,  as  digitalis  is  a  slow  poison.  In  the  treatment  of 
poisoning,  the  stomach-pump  should  be  employed.  Tannic  acid  is 
a  chemic  antidote  and  may  be  given.  Body  temperature  should  be 
maintained  by  external  heat,  especially  applied  to  the  abdomen. 
Alcoholic  stimulants  are  often  indicated.  The  patient  should  be  kept 
in  the  recumbent  position,  not  being  allowed  to  even  raise  his  hand  or 
head  from  the  bed. 

Therapeutics. — The  chief  use  of  the  drug  in  dental  therapeutics 
is  as  a  cardiac  stimulant.  Hypodermic  injections  of  the  tincture  of 
digitalis  or  of  digitalin  may  be  employed  to  increase  the  efficiency  of  the 
heart's  action  in  syncope,  collapse,  and  poisoning  by  cardiac  depress- 
ants. It  is  best  here  to  use  the  drug  in  conjunction  with  stimulants 
which  act  more  quickly  (alcoholic  stimulants).  The  drug  is  con- 
traindicated  in  cases  of  aneurysm. 

AMYLIS  NITRIS— U.  S.  P. 
(Amyl  Nitrite;  CsH„NOa.) 

Amyl  nitrite  is  prepared  by  the  action  of  nitric  acid  upon  amylic 
alcohol;  the  product,  being  a  highly  volatile  liquid,  is  obtained  by  distil- 
lation.    It  has  a  strong  ethereal  odor. 

Physiologic  Action.— Following  the  inhalation  of  amyl  nitrite 
there  is  a  marked  flushing  of  the  face,  due  chiefly  to  the  dilatation  of  the 


1 64  STIMULANTS. 

capillaries.  The  heart's  action  is  increased,  and  the  pulse  is  soft  and 
compressible.  There  is  a  marked  fall  in  blood-pressure  because  of  the 
dilatation  of  the  arterioles,  which  results  from  the  paralyzant  action  of 
the  drug  upon  the  muscle  fibers  found  in  these  structures."  The 
nitrites  cannot  be  regarded  as  powerful  cardiac  stimulants,  but  their 
action  is  equivalent  to  such,  for  by  dilating  the  arterioles  they  largely 
remove  the  resistance  against  which  the  heart  has  to  force  the  blood, 
thus  making  the  work  of  this  organ  much  easier  to  perform.  These 
drugs,  therefore,  should  be  regarded  as  vasodilators,  and  not  as  true 
cardiac  stimulants;  but,  on  account  of  their  action  as  vasodilators,  they 
may  be  considered  circulatory  stimulants.  The  drug  is  largely 
eliminated  through  the  kidneys. 

Poisoning  and  Treatment. — In  toxic  doses  amyl  nitrite  produces 
an  exceedingly  rapid  and  weak  heart,  cyanosis,  slow  and  shallow 
respiration,  vertigo,  headache,  and  disordered  vision.  Death  resulting 
from  cardiac  and  respiratory  failure.  In  the  treatment  of  poisoning  the 
heart's  action  must  be  sustained.  Strychnin  and  digitalis  will  be 
found  useful.  Atropin  may  be  administered,  together  with  cold  ap- 
plications to  the  head,  alcoholic  stimulants,  and,  if  necessary,  artificial 
respiration.  Adrenalin  is  claimed  to  be  useful  as  it  contracts  the 
dilated  arterioles. 

Therapeutics. — Long1  states  that  it  is  to  be  regretted  that  the 
nitrites  have  been  considered  direct  heart  stimulants,  because  of  this 
they  are  extensively  used  in  cases  where  the  blood-pressure  is  already 
too  low  to  permit  efficiency  of  circulation,  as  in  chloroform  and  other 
drug  poisoning.  Amyl  nitrite  is  useful  to  relax  spasms  and  to  lower 
arterial  tension.  On  account  of  the  rapidity  with  which  the  drug  is 
absorbed  it  is  never  necessary  to  give  nitrites  hypodermically.  The 
effect  of  amyl  nitrite  may  be  obtained  almost  instantly  by  inhalation, 
and  a  dose  of  spirit  of  nitroglycerin  (1-3  min. — 0.06-0.2  c.c.)  placed 
under  the  tongue  will  produce  its  full  effect  in  less  than  five  minutes. 
Amyl  nitrite  may  be  obtained  in  glass  capsules  or  pearls,  containing  the 
requisite  dose  (2-5  mm. — 0.13-0.3  c.c),  which  are  easily  crushed  in  a 
handkerchief,  and  should  always  be  given  by  inhalation.  In  this 
manner  it  may  be  employed  with  benefit  to  relieve  the  convulsions  of 
epilepsy,  tetanus,  uremia,  and  strychnin  poisoning.  The  drug  is  used  in 
syncope  and  collapse  from  other  causes,  but  the  diffusible  stimulants 
are  far  preferable. 

'  Dental  Materia  Medica,  Therapeutics  and  Prescription  Writing. 


GLYCERYLIS    MTRAS — BELLADONNA.  165 

GLYCERYLIS  NITRAS. 
(Nitroglycerin;  Glonoin;  Glyceryl  Trinitrate;  (',Hs(N03)3.) 

Nitroglycerin  is  obtained  by  nitric  acid  or  a  mixture  of  nitric 
and  sulphuric  acid  on  dehydrated  glycerin.  It  occurs  as  a  clear, 
colorless  liquid,  with  an  odor  and  taste  resembling  that  of  alcohol. 
It  explodes  with  great  force,  and  should  be  kept  in  a  cool  place,  away 
from  lights  and  fire.     It  is  official  in  the  following  form: 

Spiritus  Glycerylis  Nitratis,  U.  S.  P.  (Spirit  of  Nitroglycerin; 
an  alcoholic  solution  containing  1  per  cent,  by  weight  of 
Glyceryl   Trinitrate).     Dose,  1-3  min.  (0.06-0.2  c.c). 

Physiologic  Action  and  Therapeutics. — Nitroglycerin  is  pref- 
erable to  amyl  nitrite,  whose  action  it  resembles,  for  internal  admin- 
istration. It  is  used  in  dentistry  as  a  cardiac  stimulant,  and  for  this 
purpose  it  may  be  found  as  a  constituent  of  local  anesthetic  solutions. 
It,  however,  is  far  inferior  to  strychnin  or  atropin  as  an  agent  to  over- 
come the  depressant  effect  of  cocain  upon  the  heart. 

RESPIRATORY  STIMULANTS. 

These  are  agents  which  increase  the  functional  activity  of  the  res- 
piratory centers  or  the  efficiency  of  the  respiratory  apparatus.  The  chief 
respiratory  stimulants  are: 

Belladonna  (Atropin).  Strychnin.* 

Ammonia.*  CafTein.* 

All  of  these  drugs  have  been  elsewhere  discussed   except   the   first- 
mentioned. 

BELLADONNA. 

(Deadly  Nightshade.) 

Belladonna  is  a  herbaceous  perennial  plant  growing  in  the  woods, 
chiefly  in  the  mountainous  districts  of  central  and  southern  Europe. 
Both  the  dried  leaves  (Belladonna  Folia,  U.  S.  P.)  and  the  dried  root 
(Belladonna  Radix,  U.  S.  P.)  of  Atropa  Belladonna  are  official.  The 
drug  contains  an  important  alkaloid,  atropin,  to  which  its  physiologic 
activity  is  due.  The  dose  of  the  powdered  leaves  and  root  is  from 
1-5  gr.  (0.06-0.3  gm0-     The  following  preparations  are  official: 

Tinctura  Belladonnas  Foliorium,  U.  S.  P.  Dose,  5-20  min. 
(0.3-1.3  c.c). 

Extractum  Belladonnae  Foliorium,  U.  S.  P.  Dose,.i/8-i/4  gr. 
(0.008-0.016  gm.). 


1 66  STIMULANTS. 

Emplastrum  Belladonnae,  U.  S.  P. 

Unguentum  Belladonnae,  U.  S.  P.  (10  per  cent.). 

Fluidextractum  Belladonnas  Radicis,  U.  S.  P.     Dose,  1-3  min. 

(0.06-0.2  c.c). 

Linimentum  Belladonnae,  U.  S.  P.  (contains  Camphor,  5  parts; 

fluid  extract  of  Belladonna  Root,  95  parts). 

The  action  of  belladonna  is  due  entirely  to  atropin  which  it  con- 
tains.    This  alkaloid  is  official. 

ATROPINA— U.  S.  P. 

Atropin  occurs  in  the  form  of  white,  acicular  crystals,  or  a  crystalline 
powder,  odorless,  having  a  bitter,  acrid  taste;  soluble  in  130  parts  of 
water,  3  parts  of  alcohol,  10  parts  of  ether,  4  parts  of  chloroform,  and 
about  50  parts  of  glycerin.  One  salt  of  atropin  is  official  (Atropinas 
Sulphas,  U.  S.  P.),  and  in  appearance  resembles  the  alkaloid  itself, 
except  it  is  more  freely  soluble  in  water.  The  dose  of  atropin  or  of 
its  salt  is  from  1/120  to  1/40  gr.  (0.005-0.0016  gm.). 

Physiologic  Action. — The  action  of  belladonna  is  dependent 
upon  the  amount  of  contained  atropin.  Applied  locally  in  combina- 
tion with  absorbable  substances — alcohol,  camphor,  animal  fat, 
glycerin,  etc. — atropin  acts  as  a  depressant  to  all  highly  organized 
tissues,  exerting  an  analgesic  and  antisecretory  influence.  Medicinal 
doses  of  atropin,  taken  internally,  produce  dryness  of  the  throat, 
dilatation  of  the  pupils,  quickening  of  the  pulse,  deepening  of  the 
respirations,  and  occasionally  talkative  delirium  and  erythematous 
rash.  It  is  well  to  remember  here  that  medicinal  doses  stimulate 
the  respiratory  center,  while  toxic  doses  paralyze  it. 

The  salivary  secretion  is  lessened  through  paralysis  of  the  periph- 
eral endings  of  the  secretory  fibers  only  of  the  chorda  tympani  nerve 
in  the  submaxillary  gland  (Butler).  The  drug  also  diminishes  all 
of  the  secretions  of  the  body,  and  its  elimination  is  effected  chiefly 
through  the  kidneys. 

Poisoning  and  Treatment. — The  characteristic  symptoms 
of  atro pin-poisoning  are  dryness  of  the  throat,  dilated  pupils,  rapid 
pulse,  quick  respiration,  uneasiness,  talkative  delirium,  erythematous 
rash,  and,  ultimately,  stupor,  collapse,  and  death  from  paralysis  of  the 
respiratory  center.  In  the  treatment  of  poisoning  the  stomach  should 
be  evacuated  and  then  washed  out  with  solutions  of  tannic  acid — 
the  chemic  antidote.  Cardiac  and  other  respiratory  stimulants 
(caffein)  should  be  cautiously  administered  as  the  symptoms  indicate. 

Therapeutics.— Atropin  is  one  of  the  best  remedies  at  our  com- 


I.I  \  1 1  \\  \.  167 

mand  for  controlling  the  secretions  of  the  body.  In  cases  where  it 
is  necessary  to  keep  the  field  of  operation  dry,  as  in  treating  and  Jill  in g 
teeth  where  the  rubber  dam  cannot  be  successfully  adjusted,  atropin 
may  be  administered  a  few  hours  previous  to  operating  with  excellent 
results.  In  salivation  from  mercury  the  drug  is  likewise  useful.  In 
hypcridrosis  of  the  hands  and  feet  preparations  of  belladonna  is  used 
both  externally  and  internally.  Combined  with  camphor  and  other 
drugs,  extract  of  belladonna  is  a  useful  remedy  in  acute  coryza.  Prob- 
ably the  greatest  use  atropin  has  in  dental  therapeutics  is  in  the  treat- 
ment of  shock  and  collapse  from  local  and  general  anesthetics,  and  also 
in  the  treatment  of  poisoning  from  narcotic  drugs.  In  these  cases 
atropin  sulphate,  hypodermically  administered,  stands  next  to  strychnin 
and  its  salts. 

Liniment  of  belladonna  is  a  valuable  remedy  in  the  treatment  of 
neuralgia. 

GASTRIC  STIMULANTS. 

Gastric  stimulants,  called  also  stomachics,  are  agents  which 
sharpen  the  appetite  and  promote  the  functional  activity  of  the  stomach. 
The  gastric  stimulants  are  called  "bitter  tonics,"  and  they  include  the 
following: 

Gentian.  Cinchona.* 

Wild  Cherry.  Hydrastis.* 

Xux  Vomica.* 

GENTIANA— U.  S.  P. 

(Gentian.) 

Gentian  is  the  dried  rhizome  and  roots  of  Gcntiana  Intra,  a  small 
perennial  plant  indigenous  to  the  mountainous  districts  of  central 
Europe.  It  contains  a  bitter  glucosid,  gentiopicrin,  to  which  its  stom- 
achic property  is  due.  The  dose  is  from  5-20  gr.  (0.3-1.3  gm.).  The 
official  preparations  are: 

Tinctura   Gentianae   Composita,   U.   S.  P.    (10  per  cent,   with 

Orange  Peel  and  Cardamon  Seed).     Dose,  1-2  fl.  dr.  (4.0-8.0 

c.c). 

Fluidextractum  Gentianae,  U.  S.  P.      Dose,  15-30  min.  (1.0-2.0 

c.c). 

Extractum  Gentianae,  U.  S.  P.     Dose,  2-10  gr.  (0.13-0.6  gm.). 

Infusum  Gentianae  Compositum  (Unofficial).     Dose,  1/2  to  1  fl. 

oz.  (15.0-30.0  c.c). 


l68  STIMULANTS. 

Physiologic  Action  and  Therapeutics. — The  action  of  gentian 
is  due  to  the  bitter  glucosid  which  it  contains,  and  like  all  bitter  tonics 
its  effect  is  immediate,  due  to  the  local  action  of  the  drug.  It  aug- 
ments the  secretions  from  the  salivary  and  gastric  glands,  and  thus 
aids  digestion  and  improves  nutrition.  There  is  an  intimate  relation- 
ship between  the  stomach  and  the  senses  of  taste  and  smell,  and  any- 
thing bitter  in  the  mouth  reflexly  stimulates  the  gastric  secretion. 

Gentian  is  not  much  employed  in  dental  practice.  It  may  be 
considered  one  of  the  most  reliable  bitter  tonics.  In  pyorrhea  alveolaris 
associated  with  neuralgia  due  to  a  general  atonic  condition,  the  com- 
pound tincture  of  gentian  may  be  advantageously  combined  with  tinc- 
ture of  valerian  (equal  parts  of  the  two)  and  given  before  meals  in  tea- 
spoonful  doses.  Where  the  pyorrhea  has  caused  indigestion  an  antacid, 
like  sodium  bicarbonate,  may  be  combined  with  some  preparation  of 
gentian;  because  of  the  insolubility  of  sodium  bicarbonate  in  alcohol, 
the  compound  infusion  of  gentian  should  be  selected.  A  useful 
combination  is:  Sodium  bicarbonate,  1/2  dr.  (2.0  gm.);  compound 
infusion  of  gentian,  3  fl.  oz.  (90.0  c.c).  This  may  be  given  in  table- 
spoonful  doses,  before  meals. 

PRUNUS  VIRGINIAN  A— U.  S.  P. 

(Wild  Cherry.) 

Prunus  virginiana  is  the  bark  of  Prunus  serotina,  sl  large  tree  in- 
digenous to  North  America.  It  contains  tannic  acid,  a  bitter  principle, 
a  ferment,  emulsin,  and  a  glucosid,  amygdalin.  In  the  presence  of 
the  ferment  and  water  the  glucosid  is  broken  up  into  hydrocyanic  acid 
and  a  volatile  oil.  The  dose  of  wild  cherry  bark  is  from  1/2-1  dr. 
(2.0-4.0  gm.).     The  following  preparations  are  official: 

Fluidextractum  Pruni  Virginians,  U.  S.  P.      Dose,  1  /2-1  fl.  dr. 

(2.0-4.0  c.c). 

Syrupus  Pruni  Virginians,  U.  S.  P.     Dose,  1-4  fl.  dr.  (4.0-15.0 

c.c). 

Infusum  Pruni  Virginians,  U.  S.  P.     Dose,  1/2-2  fl.  oz.  (15.0- 

60.0  c.c). 

Physiologic  Action  and  Therapeutics. — Wild  cherry  is  a  bitter 
tonic.  It  might  also  be  considered  a  sedative  tonic.  While  it  is  pecu- 
liarly bitter,  it  is  not  unpleasant,  and  is  well  tolerated  by  the  stomach. 
The  syrup  of  wild  cherry  is  a  common  ingredient  in  "cough-mixtures," 
and  is  supposed  to  quiet  the  cough  and  allay  the  irritability  of  the  nervous 
system  in  bronchial  trouble.     This  effect  is  doubtless  due  to  the  hydro- 


MISCELLANEOUS   GROUP.  169 

cyanic  acid  which  it  contains.     The  syrup  has  an  agreeable  taste  and 
serves  as  an  excellent  vehicle  for  unpalatable  drugs. 

The  other  stomachics  have  been  discussed  under  other  headings. 

RESTORATIVE  STIMULANTS. 

These  are  agents  which  maintain  or  restore  the  bodily  functions. 
The  principal  restorative  stimulant  is: 

NORMAL  SALINE  SOLUTION. 

This  is  a  solution  of  6  parts  of  sodium  chlorid  in  1.000  parts  of 
sterile  water,  and  closely  corresponds  in  salinity  to  blood-serum.  It 
is  regarded  as  a  valuable  stimulant  in  cases  of  shock  or  collapse,  espe- 
cially from  loss  of  blood  by  hemorrhage.  It  is  injected  intravenously 
by  permitting  the  solution,  quite  hot,  to  run  slowly  through  a  large- 
sized,  long  hypodermic  needle  from  a  fountain  syringe  into  the  lumbar 
region  or  underneath  the  breast.  From  2  fl.  oz.  (60.0  c.c.)  to  10  fl.  oz. 
or  even  1  qt.  (300.0-1,000  c.c.)  may  be  used  at  frequent  intervals. 
Sollmann1  states  that  the  action  is  only  short,  and  the  injection  must 
therefore  be  repeated.  The  restoration  is  brought  about  -by  the 
substitution  of  this  fluid  for  the  blood-serum.  The  solution  is  an 
excellent  bland  remedy  to  be  used  in  establishing  sinuses  associated 
with  alveolar  abscesses,  and  also  as  a  vehicle  for  local  anesthetics  and 
other  agents  (adrenalin,  etc.). 

MISCELLANEOUS  GROUP. 

There  are  several  drugs  which  have  a  peculiar  action  upon  the 
nervous  system  other  than  those  thus  far  discussed  under  the  various 
headings  of  general  remedies.  Some  of  these  drugs  stimulate,  while 
others  depress  the  nervous  system.  They  will  be  considered  here 
under  this  heading.     Those  of  importance  to  dentists  are: 

Gelsemium.  Valerian. 

GELSEMIUM— U.  S.  P. 
(Yellow  Jasmine.) 

Gelsemium  is  the  dried  rhizone  and  roots  of  Gelsemium  semper- 
virens,  a  climbing  plant  growing  in  the  moist  woods  of  southern  L'nited 
States.  It  contains  two  alkaloids — gelsemin  and  gelsemin  in — the 
former  stimulates,  while  the  latter  depresses  the  nervous  system.  The 
general  effect  of  the  drug  is  the  result  of  a  blending  of  the  actions  of 

1  A  Text-Book  of  Pharmacolo^v . 


I70  STIMULANTS. 

the  two  alkaloids,  although  in  man  gelseminin  appears  to  be  more 
potent.  The  dose  of  powdered  gelsemium  is  from  2-5  gr.  (0.13-0.3 
gm.).     The  official  preparations  are: 

Tinctura  Gelsemii,  U.  S.  P.     Dose,  10  to  30  min.  (0.6-2.0  c.c). 
Fluidxetractum  Gelsemii,  U.  S.  P.     Dose,  2-10  min.  (0.13-0.6' 
c.c). 

Physiologic  Action  and  Therapeutics. — Gelsemium  has  a 
distinct  action  upon  sensory  nerves  and  is  useful,  therefore,  in  painful 
affections.  In  large  doses  it  depresses  the  spinal  cord,  especially  its 
motor  neurons.  The  drug  is  used  in  trifacial  neuralgia,  and  appears 
to  be  most  serviceable  when  the  neuralgia  arises  from  diseased  condi- 
tions of  the  teeth.  The  fluid  extract  is  the  preparation  generally 
employed,  although  Marshall1  prefers  gelseminin  sulphate,  giving 
1/30  gr.  (0.002  gm.)  every  two  hours  until  the  constitutional  effects 
are  produced.  This  salt  naturally  would  be  more  effective  in  neu- 
ralgic conditions  than  gelsemium  preparations,  as  it  is  the  alkaloid 
that  depresses  the  nervous  system;  the  other  alkaloid  (gelsemin) 
stimulates. 

Poisoning  and  Treatment. — The  toxic  symptoms  of  gelsemium 
are  drooping  eyelids,  disordered  vision,  frontal  headache,  falling  of 
the  jaw,  muscular  weakness,  slow  respiration,  and,  finally,  collapse. 
In  the  treatment  of  poisoning  the  stomach  should  be  evacuated,  tannic 
acid  administered  as  the  chemic  antidote,  and  combating  collapse 
with  such  stimulants  as  strychnin,  whisky,  and  ammonia. 

VALERIANA— U.  S.  P. 

(Valerian.) 

Valerian  is  the  dried  rhizome  and  roots  of  Valeriana  officinalis, 
a  herbaceous,  perennial  plant,  native  of  Europe.  It  contains  valeri- 
anic acid  and  a  volatile  oil.  The  dose  is  from  15-30  gr.  (1.0-2.0  gm.). 
The  following  preparations  are  official: 

Tinctura  Valerianae,  U.  S.  P.     Dose,  1-2  fl.  dr.  (4.0-8.0  c.c  ). 
Tinctura  Valerianae  Ammoniata,   U.   S.  P.     Dose,   1-2  fl.   dr. 
(4.0-8.0  c.c). 

Fluidextractum    Valerianae,    U.    S.    P.      Dose,     1/2-1    fl.    dr. 
(2.0-4.0  c.c). 

Physiologic  Action  and  Therapeutics.— The  principal  action 
of  valerian  is  upon  the  nervous  system,  and  it  may  be  classed  as  a 
nervine  in  that  it  produces,  in  moderate  dose,  a  sedative  effect  upon 

1  Injuries  and  Surgical  Diseases  of  the  Face,  Mouth  and  Jaws. 


ALTERATIVES  AM  »  RESTORATIVES.  171 

the  brain  and  spinal  cord.  In  pyorrhea  alveolaris  associated  with  more 
or  less  neuralgia  due  to  a  general  atonic  condition  it  may  be  combined 
with  gentian  with  excellent  results. 

ALTERATIVES  AND  RESTORATIVES. 

Alteratives  are  agents  which  promote  metabolic  processes  and 
thus  counteract  morbid  conditions.  They  are  closely  related  to 
Restoratives  in  that  both  classes  promote  the  processes  of  nutrition 
and  aid  metabolism.  The  latter  class  includes  foods,  hematics,  and 
tonics. 

Foods  are  substances  which,  when  introduced  into  the  body, 
supply  material  with  which  some  structure  is  rebuilt  or  some  vital  proc- 
ess is  maintained.  They  differ  from  medicines  in  that  the  latter 
modify  vital  processes,  but  furnish  no  material  to  renew  the  structures 
of  the  body. 

Hematics  or  hematinics  are  agents  which  increase  the  hematin 
in  the  blood  and  restore  or  maintain  bodily  functions  by  enriching  the 
red  blood-corpuscles.     The  compounds  of  iron  are  the  chief  hematics. 

Tonics  are  agents  which  improve  the  tone  and  impart  strength  and 
energy  to  the  tissues.     The  main  tonics  are: 

Iron  and  Compounds.  Hypophosphites. 

Phosphorus.  Cod-liver  Oil. 

Calcium  Phosphate.  Nux  Vomica.* 
Cinchona.* 

The  principal  alteratives  are: 

Potassium  Iodid.  Sarsaparilla. 

Mercury.  Echafolta. 

Arsenic*  Calx  Sulphurata. 

Gold  and  Sodium  Chlorid. 

FERRUM— U.  S.  P. 

(Iron;  Fe.) 

Metallic  iron  is  official  in  the  form  of  wire. 

Physiologic  Action  and  Therapeutics. — Iron  is  an  essential 
element  of  the  body  and  may  be  regarded  as  a  food  as  well  as  a  medi- 
cine. It  enters  as  an  essential  constituent  (0.4  per  cent.)  into  a  peculiar 
proteid  body — the  hemoglobin  of  the  blood.  It  is  through  the  iron  com- 
pounds of  the  body  that  the  greater  portion  of  the  oxidizing  functions  of 
the  various  cells  are  carried  on.  In  a  healthy  state  of  the  body,  when 
the  processes  of  mastication,  digestion,  assimilation,  and  nutrition  are 


172  ALTERATIVES  AND  RESTORATIVES. 

normal,  there  is  a  sufficient  amount  of  iron  furnished  by  the  mixed  diet 
to  answer  all  physiologic  requirements;  but  in  many  pathologic  condi- 
tions there  is  a  deficiency  of  iron,  and  the  element  must  be  furnished  in 
the  form  of  selected  food  or  medicine.  There  is  a  difference  of  opinion 
as  to  whether  metallic  iron  can  be  assimilated  by  the  body;  some 
authorities  claiming  that  it  is  necessary  to  first  have  the  iron  organized 
by  plant  life  into  compounds  containing  it,  while  others  claim  that  this 
is  not  necessarily  essential  to  the  assimilation  of  the  metal.  Metallic 
iron  is  not  used  as  a  therapeutic  agent  in  dentistry.  In  medicine  it  is 
extensively  employed  in  diseases  which  affect  the  circulation,  as 
anemia  and  chlorosis.  Many  iron  compounds  are  used  in  dentistry 
and  will  here  be  considered. 

Iron  Compounds. — Iron  forms  two  series  of  compounds— -ferrous 
and  ferric.  The  former  are  white  when  freshly  precipitated  in  the 
absence  of  oxygen,  but  when  moist  and  exposed  to  air  they  readily 
absorb  oxygen  and  gradually  change  into  ferric  compounds,  which  are 
usually  reddish-brown  in  color.  In  this  change  there  is  an  array  of 
four  distinct  colors — white,  green,  black,  and  brown,  respectively — and 
in  the  blending  of  these  colors  there  may  be  produced  every  variety  of 
shades  seen  in  discolored  teeth.  As  it  is  quite  generally  conceded  that 
iron  is  the  most  important  element  to  be  considered  in  the  many 
factors  entering  into  the  complicated  problem  of  tooth  discoloration 
from  pulp  decomposition,  the  above  fact  should  be  remembered. 

With  the  exception  of  the  carbonate,  the  hydroxid,  and  the  hypo- 
phosphite,  all  of  the  compounds  of  iron  are  freely  soluble  in  water, 
but  insoluble  in  alcohol.  The  so-called  scaled  salts  are  all  ferric  com- 
pounds of  phosphoric  acid,  or  the  organic  acids,  citric  and  tartaric; 
they  are  rendered  more  soluble  in  combination  with  citrates,  tartrates, 
and  phosphates  of  the  respective  alkalies — ammonium,  potassium,  and 
sodium — and  some  are  known  as  "soluble"  salts.  The  scale  salts  are 
comparatively  free  from  astringency,  usually  well  borne  by  the  stomach, 
and  are  used  in  medicine  as  mild  and  agreeable  hematinics.  The  dose, 
with  one  exception  (that  containing  strychnin),  is  4  gr.  (0.25  gm.). 
The  official  Latin  titles  do  not  distinguish  between  the  ferrous  and 
ferric  compounds,  but  they  are  so  distinguished  in  the  English  titles. 
The  iron  compounds  used  in  dental  therapeutics  here  follow. 

FERRI  SULPHAS— U.   S.  P. 
(Ferrous  Sulphate;  Green  Vitriol;   FeS04.7H20.) 

Ferrous  sulphate  occurs  in  the  form  of  bluish-green,  efflorescent 
prisms,  odorless,  having  a  saline,  styptic  taste.     It  is  freely  soluble  in 


IRON    COMPOUNDS.  173 

water,  insoluble  in  alcohol.     The  dose  is  from  1-5  gr.  (0.06-0.3  gm0- 
The  official  preparations  are: 

Ferri  Sulphas  Exsiccatus,  U.  S.  P.  Dose,  1-3  gr.  (0.06-0.2  gm.). 
Ferri  Sulphas  Granulatus,  U.S.  P.     Dose,  1-5  gr.  (0.06-0.3  gm.). 

Physiologic  Action  and  Therapeutics. — Iron  sulphate  is  an 
active  astringent.  It  may  be  applied  to  canker  sores,  but  is  inferior  to 
copper  sulphate.  It  is  frequently  used  as  a  deodorant  for  privies 
and  cesspools. 

FERRI  SUB  SULPHAS— Unofficial. 

(Ferric  Subsulphate;  Basic  Ferric  Sulphate;  Monsel's  Salt; 

Fe40(S04)s.) 

Ferric  subsulphate  occurs  as  a  yellow,  hygroscopic,  astringent 
powder,  freely  soluble  in  water.     There  is  one  official  preparation: 

Liquor  Ferri  Subsulphatis,  U.  S.  P.  (Monsel's  Solution).  Dose, 
3-5  min.  (0.2-0.3  c-c-)- 

Physiologic  Action  and  Therapeutics. — Monsel's  salt  or  the 
official  solution  (Monsel's  solution)  is  a  prompt  and  powerful  styptic, 
and  as  such  it  has  long  been  used  in  dentistry.  When  the  hemorrhage 
proceeds  from  a  tooth-socket  it  is  better  to  use  the  salt  than  the  solution, 
for  the  reason  that  the  hard  black  clots  formed  by  the  latter  may  conceal 
the  deep-seated  hemorrhage.  The  salt  can  be  incorporated  in  moist 
cotton  and,  after  washing  the  socket,  the  medicated  cotton  should  be 
packed  tightly  into  it.  Sometimes  it  is  necessary  to  hold  the  packing 
firmly  for  some  time  in  order  to  control  the  hemorrhage. 

FERRI  CHLORIDUM— U.  S.  P. 

(Ferric   Chlorid;   Iron   Perchlorid;    FeXl6-i2H,0.) 

Ferric  chlorid  occurs  in  orange-yellow,  crystalline  pieces,  having 
an  astringent  taste.  It  is  a  highly  deliquescent  salt,  and  therefore 
freely  soluble  in  water,  also  in  alcohol.     The  official  preparations  arc: 

Liquor  Ferri  Chloridi,  U.S. P.  Dose,  3-10  min.  (0.2-0.6  c.c). 
Tinctura  Ferri  Chloridi,  U.  S.  P.  Dose,  5-30  min.  (o .  3-2.0  c.c). 
Liquor  Ferri  et  Ammonii  Acetatis,  U.  S.  P.  Dose.  14  ll.  dr. 
(4.0-15.0  c.c). 

Physiologic  Action  and  Therapeutics. — Ferric  chlorid  is  an 
active  astringent  and  styptic.  It  is  employed  in  the  control  of  hemor- 
rhage, after  the  extraction  of  teeth,  removal  of  small  growths,  etc. 


174  ALTERATIVES  AND   RESTORATIVES. 

As  a  styptic  in  dental  therapeutics,  it  is  inferior  to  Monsel's  solution 
or  salt.  The  tincture  has  a  deleterious  action  upon  the  teeth,  and 
should  be  used  about  the  mouth  with  caution. 

Ferrum  Dialysatum  (Dialysed  Iron). — This  is  an  unofficial 
preparation  of  iron  oxychlorid  from  which  acidulous  matter  has  been 
separated  by  dialysis,  hence  the  name,  dialysed  iron.  It  is  a  dark  red, 
neutral  liquid,  without  odor  or  taste.  It  has  been  employed  freely 
as  a  local  antidote  in  arsenical  poisoning.  Dentists  have  been  prone 
to  rely  upon  this  agent  when  other  remedies  would  serve  better 
(see  p.  291). 


FERRI  CARBONAS— Unofficial. 

(Ferrous  Carbonate;  FeC03.) 

Ferrous  or  iron  carbonate  is  an  unstable  compound  which  is 
readily  converted  into  ferric  hydroxid  (hydrate)  when  moist  and 
exposed  to  air — a  characteristic  of  most  ferrous  compounds.  The  salt 
may  be  protected  from  oxidation  and  enters  into  the  following  official 
preparations: 

Ferri  Carbonas  Saccharatus,  U.  S.  P.     Dose,  5-15  gr.  (0.3-1.0 

gm.). 

Mistura  Ferri  Composita,  U.  S.  P.     Dose,  1-4  fl.  dr.  (4.0-15.0 

c.c). 

Massa  Ferri  Carbonatis,  U.  S.  P.  (Vallet's  Mass).     Dose,  3-5  gr. 

(0.2-0.3  gm.). 

Pilulae  Ferri  Carbonatis,  U.  S.  P.  (Blaud's  Pills,  each  containing 

one  gr.  of  pure  Ferrous  Carbonate).     Dose,  1-3  pills. 

Physiologic  Action  and  Therapeutics. — Ferrous  carbonate 
acts  as  a  tonic,  and  the  preparations  containing  it,  being  free  from 
astringency,  may  be  used  whenever  iron  is  demanded  by  the  tissues. 
The  preparations  are  especially  useful  in  anemia. 


FERRUM   REDUCTUM— U.   S.  P. 

(Reduced  Iron;  Iron  by  Hydrogen.) 

Reduced  iron  occurs  as  a  fine,  grayish-black,  insoluble  powder, 
without  odor  or  taste.  It  should  contain  not  less  than  90  per  cent,  of 
metallic  iron.  It  is  a  valuable  hematinic,  as  it  is  free  from  astringency 
and  has  little  tendency  to  cause  constipation.  The  dose  is  from  1-5  gr. 
(0.06-0.3  gm.)  given  in  the  form  of  pills,  capsules,  or  lozenges. 


IRON    COMPOUNDS.  j;- 

FERRI  HYDROXIDUM     U.  S.  P.  AND  FERRI  HYDROXIDUM  CUM 
MAGNESII  OXIDO— U.   S.  P. 

(Ferric  Hydroxid;  Fe2(OH)6,  and  Ferric  Hydroxid  with  Magnesia.) 

Ferric  hydroxid  is  made  by  adding  ammonia  water  to  a  solution 
of  ferrous  sulphate,  collecting  and  washing  the  precipitate.  Ferric 
hydroxid  with  magnesia  is  made  in  th,e  same  manner  except  mag- 
nesia is  added  in  excess.  Both  preparations  are  used  exclusively  as  in- 
ternal antidotes  in  arsenical  poisoning.  They  should  be  freshly  made 
and  given  freely,  while  still  moist,  in  tablespoonful  doses  or  more  every 
few  minutes.  Ferric  hydroxid  with  magnesia  is  preferable,  as  it  requires 
no  washing  of  the  precipitate,  and  the  magnesia  itself  is  antidotal. 

FERRI  IODIDUM— Unofficial. 

(Iron  Iodid;  Fel2.) 

Ferrous  iodid  occurs  in  grayish-white,  crystalline  masses;  soluble 
in  water  with  partial  decomposition.  It  enters  as  an  essential  con- 
stituent into  the  following  official  preparations: 

Syrupus  Ferri  Iodidi,  U.  S.  P.  (5  per  cent.).    Dose,  5-60  min.  (o .  3- 

4.0  c.c). 

Pilulae  Ferri  Iodidi,  U.  S.  P.  (1  gr.-0.06  gm.,  each).     Dose,  1-3 

pills. 

Physiologic  Action  and  Therapeutics. — Iron  iodid  acts  as  an 
alterative,  and  as  such  is  used  in  certain  syphilitic  conditions.  The 
syrup  is  injurious  to  the  tooth  structure,  and  it  should  be  taken  through 
a  tube,  or  given  well  diluted  with  instructions  to  thoroughly  rinse  the 
mouth  after  its  administration. 


FERRI  HYPOPHOSPHIS— U.  S.  P. 

(Ferric  Hypophosphite.) 

This  salt  occurs  as  a  white  powder,  odorless,  and  practically  taste- 
less. It  is  but  sparingly  soluble  in  water.  The  dose  is  from  5-10  gr. 
(0.3-0.6  gm.).     It  is  contained  in  the  following  preparation: 

Syrupus  Hypophosphitum  Compositus,  N.  F.     Dose,  1-46".  dr. 
(4.0-15.0  c.c). 

This  preparation  is  adopted  from  the  National  Formulary, 
and  is  similar  to  a  number  of  proprietary  syrups  of  hypophosphites. 
The  preparation  is  used  as  an  alterative  and  hematinic. 


176  ALTERATIVES  AND  RESTORATIVES. 

PHOSPHORUS— U.  S.  P. 

(P.) 

Phosphorus  occurs  as  a  translucent,  nearly  colorless  solid,  of  a 
waxy  luster,  and  at  ordinary  temperatures  having  about  the  consistence 
of  beeswax.  When  kept  for  some  time  the  surface  becomes  red  and 
occasionally  black.  When  exposed  to  air  it  emits  white  fumes,  visible 
in  the  dark,  which  have  an  odor  somewhat  like  garlic.  Upon  pro- 
longed exposure  to  air  it  takes  fire  spontaneously.  The  drug  should  be 
carefully  kept  under  water,  in  which  it  is  practically  insoluble,  in 
strong,  well-closed  vessels.  The  dose  is  from  1/100-1/30  gr.  (0.0006- 
0.002  gm.).     The  following  preparation  is  official: 

Pilulae  Phosphori,    U.    S.    P.    (each   pill  contains    1/100  gr- 
0.0006  gm.).     Dose,  1-3  pills. 

Physiologic  Action. — Phosphorus  stimulates  the  bone-forming 
tissues,  when  given  in  small  doses,  rendering  the  bones  more  dense, 
diminishing  the  cancellous  structure,  and,  if  the  administration  of  the 
drug  is  continued,  the  marrow-cavity  becomes  more  or  less  obliterated. 
There  has  been  a  difference  of  opinion  among  investigators  as  to  how 
this  result  was  brought  about.  Some  believed  that  an  excess  of 
phosphates  was  deposited,  while  others  felt  that  it  was  due  to  a  specific 
irritation  of  the  bone-forming  cells,  causing  stimulation.  The  latter 
theory  is  more  nearly  correct,  for  Wegner  has  shown  by  a  series  of  ex- 
periments on  growing  animals  fed  with  phosphorus,  but  deprived  of 
phosphates,  that  the  same  hyperplasia  in  the  bones  resulted,  but  that 
the  new  tissue  was  soft  and  gelatinous  instead  of  hard.  The  dominant 
action  of  phosphorus  is  upon  the  osseous  system.  Stevens  claims, 
however,  that  there  is  considerable  clinical  testimony  to  show  that  the 
drug  improves  the  nutrition  of  other  tissues,  especially  of  the  nervous 
system.  Phosphorus  is  extensively  used  in  the  manufacture  of  matches, 
and  the  fumes  so  common  in  these  factories  often  produce  the  most 
serious  results.  Where  dental  caries  is  present  extensive  maxillary 
necrosis  has  been  reported  by  Brophy  and  others,  as  well  as  great  ir- 
ritation of  the  conjunctivae  and  the  respiratory  mucous  membrane. 
In  most  match  factories  a  strict  rule  is  adopted  requiring  the  em- 
ployees to  have  their  teeth  examined  at  stated  intervals  and,  if  found 
necessary,  put  in  order. 

Poisoning  and  Treatment. — The  effects  of  a  toxic  dose  of  phos- 
phorus are  not  generally  manifested  for  several  hours  after  its  ingestion. 
The  earliest  symptoms  are  intense  abdominal  pain,  persistent  vomiting, 
thirst,  a  garlicky  taste  in  the  mouth,  restlessness,  and  prostration.     At 


\<   IIH    \1     I'lMiSIMIORICUM.  177 

the  end  of  twenty-four  to  thirty-six  hours,  these  acute  sympt 
gradually  subside,  and  the  hope  is  raised  that  the  patient  will  surely 
recover,  but  frequently  after  a  lapse  of  a  few  hours,  or  even  two  or  three 
days,  the  symptoms  of  the  acute  stage  may  recur.  In  these  case-  there 
is  great  weakness,  the  symptoms  becoming  more  acute,  mucus,  bile, 
and  occasionally  disintegrated  blood  being  contained  in  the  ejected 
material,  which  for  a  time  retain  the  odor  and  luminosity  of  phos 
phorus;  jaundice  develops;  the  liver  becomes  enlarged  and  painful, 
and  the  pulse  grows  very  feeble.  In  fatal  cases  death  generally  oc- 
curs in  from  a  few  days  to  two  weeks,  and  is  often  preceded  by  delirium, 
convulsions,  stupor,  and  coma. 

In  the  treatment  of  phosphorus  poisoning,  if  the  drug  has  recently 
been  taken,  emetics  and  purgatives  are  from  the  first  necessary.  Cop- 
per sulphate  is  considered  the  most  efficient  emetic  as  well  as  the  best 
chemic  antidote,  since  any  excess  forms  with  the  phosphorus — the 
insoluble  copper  phosphid.  Since  oily  and  fatty  substances  are 
active  solvents  for  phosphorus,  all  such  material  should  be  withheld. 
Castor  oil,  then,  as  a  cathartic,  should  not  be  used. 

As  prophylactic  measures  for  the  protection  of  workmen  against 
phosphor-necrosis,  masks  covering  the  mouth  and  nose  have  been 
found  serviceable,  as  well  as  the  inhilation  of  the  vapor  of  turpentine 
obtained  by  suspending  a  small  vial  of  the  fluid  at  the  neck.  As  has 
been  mentioned,  the  teeth  should  be  examined,  especially  for  caries, 
at  stated  intervals,  since  the  presence  of  carious  teeth  favors  the  tend- 
ency to  maxillary  necrosis. 

Therapeutics. — Phosphorus  is  employed  as  a  tonic  to  the  osse- 
ous tissues  and  in  certain  diseases  of  the  nervous  system  that  are 
dependent  upon  exhaustion  rather  than  upon  organic  changes.  In 
neurasthenia  and  chronic  nervous  exhaustion  it  is  a  useful  therapeutic 
agent.  Some  cases  of  neuralgia,  particularly  of  the  fifth  nerve  and 
accompanied  by  great  debility,  may  be  relieved  by  full  doses  admin- 
istered every  four  hours  (Butler).  The  drug  has  proved  efficacious 
in  caries,  delayed  union  of  fractures,  osteomalacia,  and  rachitis 
(rickets).  In  functional  impotence  from  sexual  excess,  phosphorus 
is  also  a  valuable  remedy.  The  pill  is  considered  the  most  stable,  and 
therefore  the  best  preparation  in  which  to  administer  the  drug. 

ACIDUM   PHOSPHORICUM— U.   S.  P. 

(Phosphoric  Acid;  Orthophosphoric  Acid;  H3P04.) 

Under  Phosphorus  it  was  stated  that  when  exposed  to  air  the 
drug  burns,  emitting  white  fumes.     Chemicallv  considered,  this  means 


178  ALTERATIVES  AND  RESTORATIVES. 

that  phosphorus  combines  directly  with  oxygen  to  form  phosphorous 
pentoxid  (P2OS).  This  oxid  is  capable  of  combining  chemically 
with  one,  two,  or  three  molecules  of  water,  forming  thereby  three 
different  acids,  as: 

P205  +H20  =H2P206  =  2HP03,       Metaphosphoric  Acid. 
P2Os  +  2H20  =H4P207,  Pyrophosphoric  Acid. 

P205+3H20=H6P208  =  2H3P04,     Orthophosphoric  Acid. 

These  three  acids  show  different  reactions,  act  differently  upon 
the  animal  system,  and  form  different  salts.  The  acid  of  phosphorus 
recognized  by  the  United  States  Pharmacopeia  is  a  colorless  liquid, 
composed  of  85  per  cent,  by  weight  of  absolute  orthophosphoric  acid 
and  15  per  cent,  of  water.  It  has  a  strong  acid  taste.  The  dose  is 
from  3-5  min.  (0.2-0.3  c.c),  well  diluted.  There  is  an  official  diluted 
phosphoric  acid  {Acidum  Phosphoricum  Dilutum,  U.  S.  P.,  10  per  cent.) 
which  is  usually  employed  when  phosphoric  acid  is  indicated,  the 
dose  of  which  is  from  10-60  min.  (0.6-4.0  c.c.)  in  water. 

Physiologic  Action  and  Therapeutics. — The  action  of  phos- 
phoric acid  is  somewhat  like  that  of  the  dilute  mineral  acids,  and  has 
no  relation  to  the  action  of  phosphorus  itself.  In  medicine  the  drug 
is  used  to  allay  thirst  in  diabetes  and  febrile  diseases,  and  to  promote 
gastric  digestion.  The  acid  has  practically  no  use  in  dental  thera- 
peutics, but  is  discussed  here  because  phosphoric  acid  (modified 
somewhat)  is  the  liquid  combined  with  zinc  oxid  (cement  powder) 
to  make  the  zinc  phosphate  cement,  so  extensively  used  in  dental  practice. 
Nearly  all  of  the  phosphates  found  in  nature  are  orthophosphates. 

CALCII  PHOSPHAS  PRjECIPITATUS— U.  S.  P. 

(Precipitated  Calcium  Orthophosphate;  Bone  Phosphate;  Ca5(P04)2.) 

Precipitated  calcium  phosphate  occurs  as  a  white,  odorless, 
tasteless,  amorphous  powder;  insoluble  in  cold  water  and  alcohol. 
The  dose  is  from  5-30  gr.  (0.3-2.0  gm.).  There  is  one  official 
preparation: 

Syrupus  Calcii  Lactophosphatis,  U.  S.  P.  (contains  about  3  per 
cent,  of  the  double  soluble  salt).     Dose,  1-4  fl.  dr.  (4.0-15.0C.C.), 

Physiologic  Action  and  Therapeutics. — Calcium  phosphate 
may  be  taken  as  the  type  of  the  insoluble  salts  of  calcium,  which  are  so 
frequently  referred  to  in  dental  literature  as  "lime-salts."  Lime  is  cal- 
cium oxid,  and  as  there  is  no  such  thing  in  chemistry  as  a  salt  of  an 
oxid,  this  term,  lime-salts,  should  be  discarded.  When  taken  internally, 
calcium  phosphate,  for  the  most  part,  resists  absorption  and  reappears 


CALCI1    HYPOPHOSPHK.  [79 

in  the  stools;  a  small  amount,  however,  is  assimilated,  and  in  case  of  a 
deficiency  of  phosphates  in  the  food  is  appropriated  by  the  tissues. 
Where  the  phosphates  in  the  natural  food-supply  meet  all  physiologic 
requirements,  any  excess  of  the  insoluble  calcium  salts  is  slowly  ex- 
creted by  the  intestinal  epithelium  and  kidneys.  Food  ordinarily  con- 
tains more  calcium  phosphate  than  the  body  requires;  it  is,  therefore, 
difficult  to  explain  how  the  insoluble  salts  of  calcium  (phosphate  and 
hypophosphite),  administered  as  a  remedy,  can  be  of  any  physiologic 
importance.  Stevens'  states  that  the  difficulty,  however,  is  no  greater 
than  that  which  is  encountered  in  attempting  to  explain  the  undoubted 
efficacy  of  iron  in  chlorosis,  a  disease  that  is  certainly  not  dependent 
upon  a  want  of  iron  salts  in  the  food.  There  is  no  convincing  evidence 
to  show  that  the  insoluble  calcium  salts  are  of  much  value  in  them- 
selves as  therapeutic  agents.  On  theoretical  grounds  they  have  been 
prescribed  to  prevent  the  rapid  decay  of  teeth  during  pregnancy  and  the 
nursing  period,  in  osteomalacia,  and  in  rachitis.  They  seem  to  exert  a 
favorable  influence  on  general  nutrition  in  such  diseases  as  chlorosis, 
anemia,  scrofula,  tuberculosis,  tertiary  syphilis,  and  neurasthenia. 
Calcium  phosphate  may  be  given  in  powders  or  capsules;  the  lacto- 
phosphate,  being  soluble,  may  be  administered  in  the  form  of  the 
official  syrup  or  in  an  emulsion  of  cod-liver  oil. 

As  a  vehicle  for  making  pastes  used  in  capping  pulps,  filling  tor- 
tuous root  canals,  bleaching  teeth,  etc.,  the  author  recommends  combining 
precipitated  calcium  phosphate  with  thymol  (2  per  cent.).  This  will  be 
explained  in  Practical  Therapeutics. 

CALCII  HYPOPHOSPHIS— U.  S.  P. 

(Calcium  Hypophosphite;  Ca(PH202)2.) 

Calcium  hypophosphite  occurs  in  colorless,  transparent  crystals, 
or  small  lustrous  scales,  having  a  bitter,  nauseating  taste.  It  is  soluble 
in  about  7  parts  of  water,  insoluble  in  alcohol.  The  dose  is  from 
5-30  gr.  (0.3-2.0  gm.).  It  enters  as  an  important  constituent  into  the 
following  official  preparations: 

Syrupus  Hypophosphitum,  U.  S.  P.     Dose,  1 — 2  fl.  dr.  (4.0 — 8.0  c.c). 
Syrupus  Hypophosphitum  Compositus,  U.  S.  P.     Dose,  1-2  fl. 
dr.  (4.0-8.0  c.c). 

Emulsum  Olei  Morrhuae  cum  Hypophosphitibus,  U.  S.  P.  (emul- 
sion of  Cod-liver  Oil  with  Hypophosphites).      Dose,  1-8  fl.  dr. 
(4.0-30.0  c.c). 
1  Modern  Materia  Medica  and  Therapeutics 


l8o  ALTERATIVES  AND  RESTORATIVES. 

Physiologic  Action  and  Therapeutics. — The  action  of  hypo- 
phosphites,  of  which  the  calcium  salt  is  a  fair  representative,  is  similar 
to  that  of  calcium  phosphate,  and  they  may  be  employed  as  therapeutic 
agents  in  the  same  class  of  cases  in  which  the  latter  has  been  recom- 
mended. Calcium  hypophosphite,  being  more  soluble  in  water,  may 
be  assimilated  more  readily,  but  the  same  remarks  hold  true  with  this 
agent  as  were  made  with  calcium  phosphate  in  regard  to  the  power  of 
the  system  to  utilize  the  agent  in  the  constructive  processes  of  the  body. 

OLEUM  MORRHUAE— U.  S.  P. 
(Cod-liver  Oil.) 

Cod-liver  oil  is  a  fixed  oil  obtained  from  the  fresh  livers  of  Gladus 
morrhua  and  other  species  of  Gladus.  It  occurs  as  a  thin,  pale  yellow 
liquid,  having  a  characteristic  fishy  odor  and  taste.  It  contains  the 
glycerids  of  olein,  palmitin,  and  stearin,  traces  of  iodin,  bromin, 
chlorin,  phosphorus,  sulphur,  biliary  salts,  and  several  alkaloids 
(leucomains) .  The  dose  is  from  1-4  fl.  dr  (4. -15.0  c.c).  The  official 
preparations  are: 

Emulsum  Olei  Morrhuae,  U.  S.  P.  (50  per  cent.).     Dose,  1-8  fl. 
dr.  (4.0-30.0  c.c). 

Emulsum  Olei  Morrhuae  cum  Hypophosphitibus,  U.  S.  P.  (Cod- 
liver  Oil  50  per  cent.,  with  Calcium,  Potassium,  and  Sodium  Hypo- 
phosphites).     Dose,  1-8  fl.  dr.  (4.0-30.0  c.c). 

Physiologic  Action  and  Therapeutics. — From  the  constituents 
of  cod-liver  oil  it  may  readily  be  seen  that  it  is  a  food  rather  than  a 
medicine,  and  is  a  true  restorative.  In  moderate  doses  it  improves 
the  general  nutrition,  increases  the  number  of  red  blood-corpuscles, 
and  favors  the  accumulation  of  fat — a  normal  and  necessary  constit- 
uent of  the  body.  Fat  is  the  fuel  used  to  supply  energy,  and  the  most 
active  tissues  and  organs  require  the  most  fuel.  Consequently,  nerves, 
muscles,  and  glands  are  more  abundantly  supplied  with  fat  than 
cartilage;  and,  in  cases  of  starvation,  those  structures  demanding  the 
greater  supply  must  have  it,  at  the  expense  of  the  less  highly  organized 
and  active  tissues.  This  is  illustrated  in  certain  diseases — tubercu- 
losis, for  example.  Butler1  states  that  the  blood  contains  about  one- 
half  of  1  per  cent,  of  fat;  the  muscles,  3  per  cent. ;  the  brain,  8  per  cent. ; 
and  the  nerves,  22  per  cent.  This  equilibrium  must  be  maintained,  in 
order  that  the  various  cells  of  the  body  may  possess  sufficient  vitality 

1  Text-Book  of  Materia  Medica,  Therapeutics  and  Pharmacology. 


POTASSII   IODIDIM.  l8l 

to  physiologically  resist  the  encroachments  of  disease  and  the  invasion 
of  pathogenic  bacteria.  It  is  rather  difficult  to  digest  and  assimilate 
ordinary  fat;  and  this  must  be  done  before  it  can  enter  the  various  cells 
of  the  body  and  act  as  a  food,  and,  consequently,  be  a  source  of  energy. 
Cod-liver  oil  is  more  readily  absorbed  and  oxidized  than  any  other 
fat,  due  to  the  fact  that  it  has  already  been  prepared  by  the  liver,  and 
therefore  partially  elaborated;  and  also  to  the  biliary  salts  which  it 
contains,  causing  it  to  pass  more  readily  through  animal  membranes. 
Therapeutics. — Cod-liver  oil  is  a  valuable  restorative  in  all 
emaciating  diseases  resulting  in  anemia.  It  is  especially  indicated 
as  a  nutritive  tonic  in  tuberculosis.  As  a  food  it  may  be  given  in  any 
case  where  fat  is  deficient,  and  therefore  needed  to  supply  energy  to 
the  tissues. 

POTASSII  IODIDUM— U.  S.  P. 

(Potassium  Iodid;  KI.) 

Potassium  iodid  occurs  as  colorless,  transparent  or  translucent 
crystals  or  as  a  white  granular  powder,  having  a  pungent,  saline  taste; 
soluble  in  0.75  part  of  water,  2.5  parts  of  glycerin,  and  18  parts  of 
alcohol.  The  usual  dose  is  from  3-10  gr.  (0.2-0.6  gm.),  given  well 
diluted  after  meals;  but  in  tertiary  syphilis  often  1  dr.  (4.0  gm.)  may 
be  given  with  advantage.     There  is  one  official  preparation: 

Unguentum  Potassii  Iodidi,  U.  S.  P.  (contains  Potassium  Iodid, 
12  per  cent.;  Sodium  Hyposulphite,  1  per  cent.).  The  drug  is 
also  a  constituent  of  Lugol's  Solution  (Liquor  Iodi  Composilus, 
U.S.  P.). 

Physiologic  Action. — Potassium  iodid  is  a  true  alterative  and 
has  a  favorable  action  in  a  variety  of  morbid  conditions.  As  is  true 
with  many  drugs,  potassium  iodid,  given  in  a  single,  moderate  dose 
in  health,  produces  no  noticeable  effects  beyond  a  slight  increase  in 
the  secretion  of  urine  and  some  disturbance  of  the  stomach,  due  solely 
to  its  local  irritant  property.  The  drug  is  rapidly  absorbed  from  all 
parts  of  the  digestive  tract,  and  reappears  in  the  secretions  in  less  than 
fifteen  minutes  after  its  ingestion.  By  far,  the  greater  portion  is  elimi- 
nated through  the  kidneys,  but  small  quantities  escape  in  almost  even- 
secretion  of  the  body,  as  in  the  saliva,  milk,  perspiration,  and  even 
the  tears.  There  is  little  doubt  but  what  a  small  quantity  of  the  drug 
is  retained,  for  a  time  at  least,  by  the  cells  of  the  body  and  that  the 
cumulative  action  may  result,  for  its  continuous  use  is  generally  fol- 
lowed, sooner  or  later,  by  a  group  of  symptoms  known  as  iodism.    This 


l82  ALTERATIVES   AND    RESTORATIVES. 

condition  has  previously  been  mentioned,  and  in  this  instance 
results  from  the  local  irritant  effects  of  free  iodin,  into  which  a  por- 
tion of  the  iodid  appears  to  be  converted.  There  is  a  remarkable 
variance  in  the  susceptibility  of  individuals  to  the  iodids,  and  idiosyn- 
crasies are  frequently  encountered.  The  amount  of  the  drug,  there- 
fore, required  to  induce  iodism  depends  upon  the  subject.  Daily 
doses  of  from  1/4-1/2  oz.  (7.5-15.0  gm.)  are  sometimes  well  borne, 
and,  on  the  other  hand,  doses  of  from  2-3  gr.  (0.13-0.2  gm.)  a  day 
may  soon  produce  intense  discomfort. 

Therapeutics. — Potassium  iodid  is  the  one  drug  relied  upon  in 
nearly  all  cases  where  an  alterative  drug  is  indicated.  Its  best  effects 
are  observed  in  tertiary  syphilis,  in  which  stage  of  the  disease  its 
efficacy  is  equal  to  that  of  mercury  in  the  secondary  stage.  The 
initial  dose  should  be  small,  and  the  amount  gradually  increased  until 
improvement  follows  or  symptoms  of  iodism  appear.  It  is  necessary 
in  syphilis  to  continue  the  treatment  for  six  months  or  a  year  if  per- 
manent results  are  to  be  expected. 

In  acute  alveolar  abscess  the  author  has  secured  excellent  results 
in  many  cases  by  the  repeated  internal  administration  of  small  doses 
of  potassium  iodid.  The  nauseating  taste  can  by  masked  by  dissolving 
1  dr.  (4.0  gm.)  of  the  drug  in  3  fl.  oz.  (90.0  c.c.)  of  the  compound 
syrup  of  sarsaparilla  or  syrup  of  wild  cherry.  One  teaspoonful  in 
water  can  be  given  every  two  hours  until  three  or  four  doses  have  been 
taken. 

Potassium  iodid  has  been  combined  with  expectorants,  and  used 
with  advantage  in  chronic  bronchitis,  when  the  sputum  is  composed  of 
thick,  viscid  mucus.  In  morbid  conditions  of  the  mucous  membrane 
in  chronic  catarrh  the  drug  is  also  useful.  In  actinomycosis,  occurring 
in  man,  the  drug  has  been  used  internally  with  complete  success  as  a 
curative  remedy  in  a  number  of  cases  (Stevens). 

Potassium  iodid  is  highly  efficacious  in  chronic  metallic  poisoning, 
especially  from  lead  and  mercury  as  it  aids  in  the  elimination  of  the 
metal  by  forming  with  it  in  the  tissues  a  double  soluble  salt. 

OTHER  IODIDS. 

There  are  iodids  of  several  metals  used  in  medicine.  Sodium, 
ammonium,  and  strontium  iodid  resemble  potassium  iodid  in  their 
action,  and  may  be  used  for  the  same  purposes;  but  they  do  not  possess 
the  virtues  to  the  same  degree  ascribed  to  the  potassium  salt.  Zinc 
iodid  has  different  properties,  due  to  the  zinc  ion,  and  has  been  else- 
where discussed. 


HYDRARGYRUM.  183 

HYDRARGYRUM — U.  S.  P. 
Mercury;  Quicksilver;  Hg.) 

Mercury  is  a  shining,  silver-white,  heavy  metal,  without  odor  or 
taste.  It  is  a  liquid  at  the  ordinary  temperature,  and  easily  divided 
•into  spherical  globules j  but  when  cooled  to — 39.38°  C.  ( — 38.88°F.), 
it  forms  a  ductile,  malleable  mass.  The  metal  is  insoluble  in  ordinary 
solvents,  but  miscible  with  sacchareous  substances  and  fats,  through 
which,  by  trituration,  the  globules  may  be  so  finely  divided  as  not  to  be 
discernible  by  the  naked  eye,  in  which  condition  the  drug  is  very  active 
medicinally. 

Mercury  is  lardy  used  in  therapeutics  in  the  form  of  its  compounds, 
but  there  are  several  official  preparations  in  which  metallic  mercury 
is  incorporated,  after  being  reduced  to  the  finely  divided  condition. 
They  are: 

Hydrargyrum  cum  Creta,  U.  S.  P.  (contains  38  per  cent,  of 
Mercury).     Dose,  1/2-iogr.  (0.03 — 0.6  gm.). 
Unguentum  Hydrargyri,  U.  S.  P.  (contains  50  per  cent,  of  Mer- 
cury). 

Unguentum  Hydrargyri  Dilutum,  U.  S.  P.  (Blue  Ointment;  con- 
tains 7,^  per  cent,  of  Mercury;  made  by  mixing  Ointment  of  Mer- 
cury, 2;  Petrolatum,  1  part). 

Massa  Hydrargyri,  U.  S.  P.  (pill  mass  of  Mercury;  contains  ^3 
per  cent,  of  Mercury). 

Emplastrum  Hydrargyri,  U.  S.  P.  (contains  30  per  cent,  of  Mer- 
cury with  Lead  Plaster,  with  addition  of  Lanolin,  10  per  cent.). 
Oleatum  Hydrargyri,  U.  S.  P.  (contains  25  per  cent,  of  Mercury). 

Physiologic  Action. — Mercury  is  an  alterative  and  tonic. 
Every  dentist  should  be  thoroughly  familiar  with  the  action  and 
effects  of  this  metal.  When  small  doses  of  an  unirritating  prepara- 
tion of  the  drug  are  given  continuously  for  a  certain  length  of  time, 
the  first  effects  are  observed  in  the  mouth,  for  it  has  a  selective 
influence  upon  the  gums,  jaws,  and  adjacent  structures.  There  is 
produced  an  increased  flow  of  saliva,  fetor  of  the  breath,  redness 
of  the  gum  margins,  and  pericementitis,  causing  soreness  of  the 
teeth  when  the  jaws  are  forcibly  brought  together.  If  the  drug  is  not 
withdrawn  upon  the  appearance  of  these  symptoms,  the  condition  grad- 
ually grows  worse;  salivation  becomes  excessive  (continual  drooling), 
the  gums  become  swollen  and  spongy,  the  teeth  loosened  in  their  sockets 
and  may  be  easily  extracted  with  the  fingers,  the  tongue  and  parotid 
glands  enlarge — the  former  sometimes  to  the  extent  that  it  protrudes 
from  the  mouth,  and,  finally,  the  soft  tissues  slough  away,  necrosis  of 


184  ALTERATIVES  AND  RESTORATIVES. 

the  bones  set  in,  and  large  sequestrums  form.  This  group  of  symptoms 
is  known  as  ptyalism.  In  these  cases  the  general  health  is  naturally 
affected,  the  patient  becoming  pale  and  loses  flesh.  Chronic  mercurial 
poisoning  occurs  most  frequently  in  workmen  who  handle  the  metal 
or  who  are  exposed  to  its  fumes,  such  as  makers  of  thermometers, 
mirrors,  scientific  instruments,  etc.  It  is  too  frequently  induced, 
however,  by  the  prolonged  use  of  mercury  as  a  medicine. 

The  drug  is  supposed  to  enter  into  the  composition  of  the  cell  by 
combining  with  the  nucleinic  acid,  forming  mercury  nucleinate.  It  is 
absorbed  gradually,  and  although  every  secretion  of  the  body  contributes 
to  its  general  expulsion  from  the  system,  traces  of  the  drug  have  been 
detected  in  the  urine  months  after  its  use  had  been  discontinued.  It  is, 
therefore,  one  of  the  slowest  drugs  known  to  be  eliminated,  and  its 
cumulative  action  is  a  well-established  fact. 

Treatment  of  Poisoning. — If  the  symptoms  of  ptyalism  are  not 
too  pronounced,  discontinuance  of  the  mercury  and  mouth  hygiene 
usually  clear  up  the  symptoms.  In  more  severe  cases,  besides  dis- 
continuing the  use  of  mercury  and  employing  prophylactic  measures, 
certain  medicinal  remedies  are  indicated.  The  teeth  should  not  be 
extracted,  unless  so  loose  that  they  virtually  fall  out.  Potassium 
chlorate  can  be  dissolved  in  cinnamon  water  (10  gr.-o.6  gm.  to  the  fl. 
oz. — 30.0  c.c.)  and  used  as  a  mouth- wash.  Atropin,  in  medicinal  doses, 
may  be  used  twice  daily  to  control  the  flow  of  saliva.  The  internal 
administration  of  potassium  iodid  is  recommended,  as  it  aids  in  the 
elimination  of  mercury  by  forming  with  it  in  the  tissues  the  double 
soluble  salt.  Where  necrosis  of  the  bones  is  evident,  Cook  and 
Mawhinney  recommend  the  local  application  of  a  50  per  cent,  solution 
of  phenolsulphonic  acid.  This  agent  acts  as  a  stimulant  and  hastens 
the  formation  of  the  sequestra.  When  the  pain  is  very  severe,  morphin 
may  be  given;  and  tonics  are  indicated  to  combat  the  exhaustion  and 
anemia. 

Therapeutics. — Mercury  and  its  compounds  are  used  in  general 
therapeutics  for  a  variety  of  purposes.  They  act  as  antisyphilitics, 
antiparasitics,  disinfectants,  cathartics,  and  diuretics,  as  well  as 
alteratives  and  tonics. 

In  syphilis,  mercurials  and  the  iodids  act  as  specifics.  Sollmann » 
states  that  the  use  of  the  former,  as  yet,  rests  entirely  upon  an  empirical 
basis.  It  is  not  even  known  whether  the  action  of  mercury  here  is  due 
to  specific  toxicity  for  the  virus  of  syphilis,  or  whether  it  is  due  simply 
to  the  general  effects  upon  metabolism.     The  former  seems  to  be  the 

1  A  Text-Book  of  Pharmacology. 


COMPOUNDS  OP  MERCURY.  185 

case.  There  is  no  reason  to  doubt  that  mercury  is  not  only  palliative, 
but  curative,  in  the  secondary  stage  of  syphilis,  congenital  as  well  as 
acquired;  while  it  is  useless  in  the  first  and  third  stages.  The  first 
stage  is  best  treated  expectantly;  the  third,  with  iodids.  Syphilographers 
have  learned  from  sad  experience  that  mercury  can  be  pushed  much 
further  in  the  treatment  of  secondary  syphilis  without  producing 
ptyalism  if  the  mouth  has  first  been  placed  in  a  hygienic  condition,  i.e., 
if  all  irritant  (deposits,  overhanging  fillings,  etc.)  have  been  removed 
by  thorough  prophylactic  treatment. 

The  preparations  most  frequently  prescribed  in  syphilis  are 
mercury  with  chalk  and  compounds,  like  the  bichlorid,  biniodid,  and 
protiodid.     The  ointments  are  used  by  inunction. 

In  pediculosis  pubis  (crab-lice)  the  parasites  are  quickly  de- 
stroyed by  rubbing  into  the  affected  parts  a  small  amount  of  blue 
ointment. 

It  is  the  compounds  of  mercury  that  are  most  valuable  in  dental 
therapeutics.  Mercury,  however,  is  used  extensively  in  the  amalgama- 
tion of  dental  alloys  in  the  preparation  of  dental  amalgams,  which 
occupy  a  prominent  place  in  dental  practice  as  filling  material  for  teeth. 

Many  homeopathic  practitioners  object  strenuously  to  the  use  of 
amalgams  for  filling  the  cavities  in  the  teeth  of  their  patients;  some  go  so 
far  as  to  order  all  amalgam  fillings  removed  and  fillings  of  other 
material  substituted,  in  the  belief  that  enough  mercury  is  gradually 
absorbed  to  cause  systemic  disturbances.  The  idea  is  certainly  far- 
fetched, for  while  metallic  mercury  can  be  separated  from  an  amalgam 
by  high  compression  or  heat,  it,  nevertheless,  is  combined  in  the  amal- 
gam by  a  more  or  less  definite  chemic  union.  The  author  has  no 
positive  proof  to  show  that  mercury  cannot  be  thus  absorbed;  but  by 
close  observation  in  a  long  clinical  experience  no  constitutional  disturb- 
ances from  this  source  have  been  discovered.  The  same  objections  are 
offered  to  the  wearing  of  a  red-rubber  denture,  because  mercury  com- 
pounds (oxids)  are  used  as  pigments  for  coloring  the  rubber.  Surely, 
with  the  high  heat  necessary  for  vulcanization,  the  mercury  would 
combine  with  the  other  elements  to  form  such  insoluble  (nonabsorb- 
able) compounds  that  there  would  be  no  danger  of  systemic  disturb- 
ances from  this  source. 

COMPOUNDS  OF  MERCURY. 

Mercury,  like  iron,  forms  two  series  of  compounds  which  are  not 
distinguished  in  their  Latin  titles  as  they  are  in  their  English  titles: 
mercurous  and  mercuric.     The  former  are  sparingly  soluble  and  less 


l86  ALTERATIVES  AND  RESTORATIVES. 

active,  while  the  latter  are  more  readily  soluble  in  water  and  alcohol 
and  so  irritant  as  to  be  classed  with  the  poisons.  The  two  classes  also 
differ  somewhat  in  regard  to  their  physiologic  activity.  The  mercur- 
ous  compounds,  of  which  the  chlorid  (calomel)  is  a  type,  powerfully 
stimulate  the  glandular  system  and  are  antiseptics,  alteratives,  and 
cathartics.  The  mercuric  compounds,  of  which  the  chlorid  (corrosive 
sublimate)  is  a  type,  are  potent  alteratives,  and  powerful  antiseptics  and 
disinfectants.  It  is  easy  to  distinguish  between  the  two  classes  by  the 
different  coloration  produced  with  lime-water  (liquor  calcis).  The 
former  (ous)  forms  a  black  precipitate,  the  latter  (ic),  a  yellow. 

HYDRARGYRI  CHLORIDUM  MITE— U.  S.  P. 

(Mild  Mercurous  Chlorid;  Calomel;  Hg2Cl2.) 

Calomel  occurs  as  a  white,  amorphous  powder,  without  odor  or 
taste.  It  is  insoluble  in  all  ordinary  solvents.  The  dose  is  from  i/io 
to  10  gr.  (0.006-0.6  gm.).  It  is  an  important  constituent  in  the 
following  official  pills: 

Pilulae  Cartharticae  Composite,  U.  S.  P.  (each  contains  Calo- 
mel,   1  gr. — 0.06  gm.,  with  Gamboge,  Compound  Extract  of 
Colycinth,  and  Extract  of  Jalap).     Dose,  1-3  pills. 
Pilulae   Antimonii    Compositae,  U.  S.  P.  (Plumber's  Pills;  each 
contains  2/3  gr. — 0.04  gm.).     Dose,  1-2  pills. 

Physiologic  Action  and  Therapeutics. — Externally  applied, 
calomel  acts  as  a  stimulant,  antiseptic,  and  desiccant.  Internally  ad- 
ministered, it  acts  as  a  cathartic,  diuretic,  and  antisyphilitic.  Zinc 
ointment  to  which  calomel,  10  gr.  (0.6  gm.)  to  the  ounce  (32.0  gm.),  has 
been  added  makes  an  excellent  application  in  subacute  and  chronic 
eczema;  and  indolent  venereal  ulcers  are  desiccated  and  much  improved 
by  dusting  them  with  calomel. 

Calomel  acts  as  a  laxative  or  purgative,  according  to  the  way  in 
which  it  is  administered  and  the  susceptibility  of  the  patient.  It  is  a 
rather  peculiar  cathartic  in  that  its  effect  does  not  increase  in  direct 
ratio  with  the  dose,  as  is  true  with  most  cathartic  drugs.  Small  doses  re- 
peated every  half-hour  until  1  or  2  gr.  (0.065-0.13  gm.)  have  been  taken 
generally  operate  more  freely  than  a  dose  of  10  gr.  (0.6  gm.)  taken  at 
once.  Calomel  produces  a  thorough  evacuation,  the  stools  being  large 
and  loose,  and  usually  charged  with  undecomposed  bile.  Whether  the 
drug  increases  the  quantity  of  bile  formed  in  the  liver  or  simply  hastens 
the  flow  through  the  intestines  and  prevents  its  reabsorption  is  an  un- 


IIVDKAKCVKI    CHI.OKIDUM    CORROSIVUM.  187 

settled  question.  Experimental  and  clinical  evidence  point  more 
strongly  to  the  latter  assumption. 

In  cases  of  a  sluggish  liver,  the  drug  has  been  used  in  small, 
oft-repeated  doses  (i  / 10  gr. -0.006  gm.)  to  advantage.  No  remedy  is  so 
useful  as  calomel  in  the  condition  known  as  "biliousness"  which  is 
characterized  by  a  thickly  coated  tongue,  fetid  breath,  heavy  urine, 
headache,  and  depression  of  spirits.  In  these  cases  1/6  gr.  (0.01  gm.) 
may  be  given  every  fifteen  or  twenty  minutes  until  1  gr.  (0.06  gm.)  has 
been  taken.  If  the  bowels  do  not  move  freely,  it  is  well  to  follow  the 
mercurial  with  a  saline  cathartic  (Epsom  salts  or  a  Seidlitz  powder). 

Incompatibles. — Calomel  is  incompatible  with  hydrochloric  acid, 
chlorids,  chlorates,  iodids,  bromids,  and  lime-water,  as  well  as  with 
alkalies,  alkaline  carbonates,  iron,  lead,  and  copper. 

HYDRARGYRI  CHLORIDUM  CORROSIVUM— U.  S.  P. 

(Mercuric  Chlorid;  Mercury  Bichlorid;  Corrosive  Sublimate;  HgCl2.) 

Mercuric  chlorid  might  well  have  been  discussed  under  the  head- 
ing of  Disinfectants,  as  it  is  for  this  purpose  only  that  it  is  used  in 
dental  therapeutics;  but  it  was  left  that  it  might  be  considered  and  dis- 
cussed here  with  the  other  compounds  of  mercury.  It  occurs  in  the 
form  of  colorless,  odorless  crystals  or  a  fine  white  powder,  having  an 
acrid,  metallic  taste.  It  is  soluble  in  13  parts  of  water  and  in  3  parts  of 
alcohol.     The  dose  is  from  1/100-1/ 12  gr.  (0.0006-0.005  gm.). 

Physiologic  Action  and  Therapeutics. — Mercuric  chlorid, 
called  usually  bichlorid  or  corrosive  sublimate,  acts  as  an  antisyphilitic 
and  tonic,  as  well  as  an  energetic  disinfectant.  It  is  for  the  latter 
action  that  it  is  extensively  employed  in  dental  as  well  as  in  general 
therapeutics. 

The  drug  is  capable  of  destroying  most  bacteria  in  solutions  as 
dilute  as  1 :  20,000,  and  their  spores  in  solutions  of  1 :  10,000.  Certain 
germs,  however,  like  the  anthrax  bacillus,  are  more  resistant  to  its 
action,  and  stronger  solutions  are  necessary  for  their  complete  destruc- 
tion. On  the  whole,  it  is  the  most  popular  of  the  disinfectants,  and 
takes  first  rank  with  surgeons  for  use  upon  the  skin  of  the  patient  and 
the  hands  of  the  operator  and  for  irrigating  infected  -wounds  and  cavities. 
For  the  patient's  skin  and  the  surgeon's  hands,  solutions  of  from 
1:1,000  to  1:500  should  be  employed;  for  large  wounds  and  cavities, 
1 :  10,000  to  1 :5,ooo;  and  for  small  wounds,  1 : 2.000.  The  drug  is  an  ir- 
ritant, and  should  not  be  used,  even  in  dilute  solutions,  on  serous 
membranes. 


e88  alteratives  and  restoratives. 

Mercuric  chlorid  has  three  disadvantages  as  a  disinfectant:  it  is 
extremely  poisonous;  it  is  readily  converted  into  an  inert  compound 
(mercury  albuminate)  in  the  presence  of  albuminous  matter,  and 
it  is  destructive  to  metal  instruments.  This  last  drawback  is  a  serious 
objection  in  dental  therapeutics;  for,  were  it  not  for  this  fact,  the 
drug  would  be  an  ideal  disinfectant  for  instruments.  It  is  energetic, 
soluble,  and  cheap.  Tartaric  or  citric  acid  may  be  advantageously 
combined  with  bichlorid  solutions  to  prevent  the  mercuric  salt  from 
forming  an  insoluble  albuminate  with  the  albumin  in  the  tissues. 
Compressed  tablets  of  mercuric  chlorid,  each  containing  7  1/2  gr. 
(0.5  gm.)  with  tartaric  or  citric  acid  are  in  common  use.  One  of  these 
tablets  dissolved  in  a  pint  (480.0  c.c.)  of  water  makes  a  1 : 1,000  solution. 

For  sterilizing  infected  dentin  a  1 :  500  solution  is  an  excellent 
remedy.  The  author  suggests  keeping  the  pure  drug  in  papers 
(chartulae)  each  containing  1  gr.  (0.06  gm.) .  By  so  doing,  an  approxi- 
mate 1:500  solution  may  be  conveniently  made  at  any  time  by  dis- 
solving the  contents  of  one  paper  in  one  ounce  (30.0  c.c.)  of  distilled 
water.  Ordinary  water,  containing  traces  of  calcium  salts,  partially 
precipitates  the  bichlorid  in  the  form  of  mercuric  oxid.  In  applying 
this  solution  to  the  tooth-structure  with  a  pledget  of  cotton  and  pliers, 
the  latter  should  be  dried  immediately  after  the  application  on  a  clean, 
aseptic  doily,  to  prevent  the  action  of  the  mercury  upon  the  instrument. 

As  a  parasiticide,  mercury  bichlorid  is  a  valuable  remedy  in 
pediculosis  pubis  and  ring-worm.  In  these  affections,  2-4  gr.  (0.13- 
0.26  gm.)  to  the  ounce  (30.0  c.c.)  of  tincture  of  benzoin  make  an 
excellent  application. 

In  syphilis  the  drug  may  be  given  in  pill  or  in  solution.  One- 
twentieth  of  a  grain  (0.003  gm-)>  gradually  increased  to  1/12  gr. 
(0.005  gm.),  may  be  given  after  meals. 


HYDRARGYRI  IODIDUM  RUBRUM— U.  S.  P. 

(Red  Mercuric  Iodid;  Mercury  Biniodid;  Hgl2.) 

Mercury  biniodid  occurs  as  a  bright  red,  amorphous  powder, 
without  odor  or  taste.  It  is  practically  insoluble  in  water,  soluble  in 
116  parts  of  alcohol,  and  freely  soluble  in  solutions  of  potassium  iodid. 
The  dose  is  from  1/50-1/ 12  gr.  (0.0012-0.005  gm-)-  There  is  one 
official  preparation: 

Liquor  Arseni  et  Hydrargyri  Iodidi,  U.  S.  P.  (Donovan's  Solu- 
tion; 1  per  cent,  of  each  Iodid).     Dose,  1-5  min. (0.06-0. 3  c.c). 


IIVDRARGYRI   IODIDU.M    FLAVUM.  189 

Physiologic  Action  and  Therapeutics. — Mercury  biniodid 
resembles  the  bichlorid  in  its  action  and  effects.  In  the  late  secondary 
stage  of  syphilis  it  may  be  combined  to  advantage  with  potassium 
iodid.  Stevens1  recommends  the  following  formula:  Mercury  bin- 
iodid, 1  gr.  (0.06  gm.);  potassium  iodid,  3  dr.  (12.0  gm.);  water, 
2  fl.  oz.  (60. 0"  c.c.) ;  compound  syrup  of  sarsaparilla,  sufficient  to 
make  4  fl.  oz.  (120.0  c.c).  The  dose  is  a  dessertspoonful  in  water 
after  meals. 

Donovan's  solution  is  given  with  benefit  in  medicinal  doses 
as  an  alterative  in  chronic  rheumatism,  tuberculosis  adenitis,  tertiary 
syphilis,  and  during  convalescence  in  many  exhaustive  diseases. 

HYDRARGYRI  IODIDUM  FLAVUM— U.  S.  P. 
(Yellow  Mercurous  Iodid;  Mercury  Protiodid;  Green  Mercury 

Iodid;  Hgl.) 

Mercury  protiodid  occurs  as  a  yellow,  amorphous  powder.  It 
is  insoluble  and  without  odor  or  taste.  The  dose  is  from  1/10- 
1/2  gr.  (0.006-0.03  gm.). 

Physiologic  Action  and  Therapeutics. — Mercury  protiodid, 
being  an  ous  compound  is  far  less  irritant  than  the  bichlorid  or  biniodid. 
It  is  considered  the  best  compound  of  mercury  for  use  in  syphilis,  and 
should  be  given  in  pills  or  capsules  to  which  a  little  opium  may  be 
added  in  case  colic  or  diarrhea  is  induced  by  its  ingestion. 

Mercurol  (Mercury  Nucleinate)  is  an  organic  compound  of 
mercury  with  nucleinic  acid  from  yeast.  It  contains  10  per  cent,  of 
metallic  mercury,  and  occurs  as  a  brownish-white  powder;  soluble 
in  water  (warm  water),  insoluble  in  alcohol.  The  dose  is  from  1/2- 
2  gr.  (0.03-0.13  gm.). 

The  drug  does  not  coagulate  albumin;  it  has  marked  bactericidal 
power,  and  possesses  the  pharmacologic  action  of  the  soluble  com- 
pounds of  mercury.  It  is  recommended  as  a  local  antiseptic  and  as 
an  antisyphilitic  remedy. 

Sublamin  (Mercuric  Sulphate-ethylene-diamin;  HgS04.2C2H4 
(NH2)2.2H20). — This  compound  is  composed  of  one  molecule  of  mer- 
curic sulphate  and  two  molecules  of  ethylenediamin  (a  compound  of 
ethylene  and  ammonia).  It  contains  about  44  per  cent,  of  metallic 
mercury,  and  occurs  in  white  needles,  odorless,  but  possessing  a  very 
disagreeable  taste;  readily  soluble  in  water  and  in  10  parts  of  glycerin, 
sparingly   soluble   in    alcohol.     It  is  only  used  externally  as  a  dis- 

1  Modern  Materia  Medica  and  Therapeutics. 


190  ALTERATIVES   AND    RESTORATIVES. 

infectant,  similar  to  mercuric  chlorid,  over  which  it  has  the  advantage 
of  being  nonirritating,  more  penetrating,  and  readily  soluble.  A 
1 :  200  solution  is  an  excellent  remedy  for  the  immediate  sterilization 
of  infected  dentin.  The  drug  will  attack  steel  instruments,  and  the 
same  precautions  must  be  observed  here  as  with  mercuric  chlorid.  It 
is  used  in  1: 1,000  solution  for  hand  disinfection,  etc.  By  a  carefully 
conducted  series  of  experiments,  Mawhinney  has  shown  that  the  time 
required  for  a  1-200  solution  to  sterilize  a  broach  was  two  minutes, 
and  he  recommends  this  strength  solution  for  sterilizing  steel  instru- 
ments. The  experience  of  the  author  with  sublamin  has  proved  it  to 
be  a  good  disinfectant,  but  that  it  attacks  steel  instruments  immersed 
in  its  solution  for  any  length  of  time. 

Incompatibles. — Sublamin  is  incompatible  with  sodium  chlorid 
and  should  not  be  exposed  to  air. 

ARSENUM. 

(Arsenic;  As.) 

Metallic  arsenic  is  not  official,  for  as  such  it  is  not  employed  as  a 
medicine.  The  chief  compound  used  in  therapeutics,  especially  dental 
therapeutics,  is  arsenic  trioxid,  which  has  been  fully  discussed  as  a 
devitalizing  agent  under  Caustics.  Certain  salts  of  arsenous  acid 
(arsenites)  and  arsenic  acid  (arsenates)  are  also  used.  The  following 
compounds  and  preparations  containing  arsenic  in  combination  are 
official: 

Arseni  Trioxidum,  U.  S.  P.  Dose,  1/60-1/20  gr.  (0.001-0.003 
gm.). 

Liquor  Acidi  Arsenosi,  U.  S.  P.  (contains  1  per  cent,  of  Arsenic 
Trioxid  and  5  per  cent,  of  dilute  Hydrochloric  Acid).     Dose, 
1-5  min.  (0.06-0.3  c-c-)- 

Liquor  Potassii  Arsenitis,  U.  S.  P.  (Fowler's  Solution;  contains 
the  equivalent  of  1  per  cent,  of  Arsenic  Trioxid  and  3  per  cent, 
of  compound  tincture  of  Lavender).  Dose,  1-5  min.  (0.06-0.3 
c.c). 

Sodii  Arsenas,  U.  S.  P.  Dose,  1/16-1/8  gr.  (0.004-0.008  gm.). 
Sodii  Arsenas  Exsiccatus,  U.  S.  P.  Dose,  1/30-1/12  gr.  (0.002 
-0.005  g™-)- 

Liquor  Sodii  Arsenatis,  U.  S.  P.  (Pearson's  Solution;  contains  1 
percent,  of  Exsiccated  Sodium  Arsenate).  Dose,  1-5  min.  (0.06 
-0.3  c.c). 

Arseni  Iodidum,  U.  S.  P.  Dose,  1/30-1/10  gr.  (0.002-0.006 
gm.). 

Liquor  Arseni  et  Hydrargyri  Iodidi,  U.  S.  P.  (Donovan's  Solu- 
tion).    Dose,  1-5  min.  (0.06-0.3  c.c). 


SARSAPARILLA.  191 

Physiologic  Action  and  Therapeutics.- --The  action  and  uses 
of  arsenic  trioxid  have  been  elsewhere  considered.  Arsenic  in  thera- 
peutic doses  acts  as  an  alterative  by  favoring  nutrition.  Just  how 
the  action  is  brought  about  is  not  understood. 

The  drug  is  used  internally  in  a  number  of  quite  diverse  pathologic 
conditions.  Its  use,  however,  is  purely  empirical.  It  stands  next  to 
iron  in  the  treatment  of  anemia.  Fowler's  solution,  although  not 
curative,  is  the  most  efficient  remedy  in  pernicious  anemia.  In  neural- 
gia dependent  upon  anemia,  arsenic  is  valuable.  The  dose  should 
be  gradually  increased  until  symptoms  of  saturation  appear.  No 
general  tonic,  except  cod-liver  oil,  is  so  efficacious  as  arsenic  in  pulmo- 
nary tuberculosis.  The  drug  has  long  been  used  with  reported  good 
results  in  diabetes  mellilus.  It  is  an  excellent  alterative  in  pyorrhea 
alveolar  is  associated  with  chronic  rheumatism  or  the  gouty  diathesis. 
The  prolonged  use  of  arsenic  (1/100-1/ 50  gr. — 0.0006-0.0012  gm.)  has 
been  spoken  of  in  the  highest  terms  in  myocardial  degeneration  and 
angina  pectoris.  In  these  cases  it  may  be  combined  advantageously 
with  strychnin,  and  sometimes  also  with  digitalis  (Stevens). 

Individuals  vary  considerably  in  their  susceptibility  to  the  action 
of  arsenic,  therefore  it  is  best  to  begin  with  small  doses  of  the  drug  and 
gradually  increase  them  as  occasion  demands.  The  indications  of 
saturation  are  puffiness  under  the  eyes,  especially  noticeable  in  the 
morning,  and  looseness  of  the  bowels  with  colicky  pains.  For  pills 
arsenic  trioxid  is  generally  selected,  and  for  solutions  the  solution  of 
potassium  arsenite  (Fowler's  solution). 

Incompatibles. — Arsenic  is  incompatible  with  salts  of  iron, 
silver,  copper,  and  ammonium,  magnesium,  calcium,  and  tannic  acid. 

SARSAPARILLA— U.   S.  P. 

Sarsaparilla  is  the  root  of  Smilax  officinalis  and  other  species  of 
Smilax,  climbing  evergreens  growing  in  swampy  forests  of  Mexico  and 
as  far  south  as  the  northern  portion  of  Brazil.  It  contains  several 
glycosids — parillin,  saponin,  and  sarsa-saponin.  The  dose  is  from 
30-60  gr.  (2.0-4.0  gm.).     The  following  preparations  are  official: 

Fluidextractum  Sarsaparillae,  U.  S.  P.     Dose,  1/2-2  fl.  dr.  (2.0- 
8. oca). 

Fluidextractum  Sarsaparillae  Compositum,  U.  S.  P.     Dose,  1/2- 
2  fl.  dr.  (2.0-8.0  c.c). 

Syrupus  Sarsaparillae  Compositus,  U.  S.  P.  (contains  fluid  ex- 
tract Sarsaparilla,  20;  fluid  extract  Glycyrrhiza,  1 .5;  fluid  extract 


I92  ALTERATIVES   AND    RESTORATIVES. 

Senna,  1.5;  Sugar,  6.5;  Oil  of  Sassafras,  Oil  of  Anise,  Oil  of 
Gaultheria,  of  each,  0.02;  Water,  to  make  100).  Dose,  1-4  fl. 
dr.  (4.0-15.0  c.c). 

Physiologic  Action  and  Therapeutics. — Sarsaparilla  owes  it 
pharmacologic  activity  entirely  to  the  saponins  which  it  contains. 
The  drug  has  been  empirically  used  as  an  alterative  in  syphilis  and 
tuberculosis  for  centuries,  but  its  action  as  such  is  no  longer  accepted  at 
the  present  time,  and  if  it  possesses  any  action  at  all  it  is  simply  that  of 
a  very  mild  nauseant  (Sollmann).  It  is  chiefly  used  in  the  form  of  the 
compound  syrup  as  a  pleasant  vehicle  for  potassium  iodid,  potassium 
bromid,  and  certain  salts  of  mercury. 

ECHINACEA— Unofficial. 

(Cone  Flower.) 

Echinacea  is  the  dried  root  of  Echinacea  angustifolia,  a  peren- 
nial herb  growing  in  the  central  and  western  portions  of  the  United 
States.  A  fluid  extract  may  be  obtained,  the  dose  of  which  is  from 
15-30  min.  (1.0-2.0  c.c).  The  dose  of  specific  echinacea  (tincture)  is 
from  5-30  min.  (0.3-2.0  c.c).  Echafolta  is  a  purified,  assayed  form  of 
echinacea.  The  dose  is  the  same.  Externally  or  for  surgical  purposes, 
it  is  considered  greatly  superior  to  any  other  preparation  of  echinacea, 
and  is  prescribed  for  the  same  conditions. 

Echinacea  was  known  to  the  Indians  as  a  cure  for  snake  poison. 
The  experiments  with  the  drug  have  been  confined  almost  entirely  to 
the  eclectic  school  of  medicine,  and  remarkable  properties,  almost 
bordering  on  the  miraculous,  are  ascribed  to  it. 

Physiologic  Action. — Applied  to  the  mucous  membrane,  a 
warm  and  tingling  sensation  is  at  once  experienced.  It  is  similar  to 
that  of  aconite,  without  the  sedative  effect.  The  sensation  persists  for 
some  time,  even  though  the  throat  is  gargled,  and  the  agent  entirely 
removed.  The  drug  actively  promotes  the  flow  of  saliva,  and  if 
swallowed  the  warmth  and  tingling  extends  down  the  esophagus  to  the 
stomach,  but  no  further  unpleasant  influence  is  observed.  In  a  short 
time  diaphoresis  is  observed,  and  the  continuation  of  the  remedy 
stimulates  the  kidneys  to  increased  action.  All  of  the  glandular 
organs  seem  to  respond  to  its  stimulating  influence,  and  their  functional 
activity  is  increased.  The  stomach  is  improved  in  its  function,  the 
appetite  increases,  the  food  is  more  perfectly  digested,  the  bowels 
operate  better,  and  absorption,  assimilation,  and  general  nutrition  are 
materially  improved.     It  encourages  secretion  and  excretion,  prevent- 


CAJ  \    STJ]  I'lllR  A  l  \.  193 

ing  further  autointoxication,  and  quickly  correcting  the  influence 
in  the  system  of  any  that  has  occurred.  It  stimulates  retrograde 
metabolism,  or  tissue  waste,  more  markedly  than  any  other  single 
remedy  known. 

There  are  but  few  subjective  symptoms  from  large  doses  of  the 
drug.  It  is  apparently  nontoxic,  and.  to  any  unpleasant  extent,  non- 
irritant.  It  has  a  marked  effect  upon  the  nervous  system,  but  its 
action  here  has  not  yet  been  determined  (Ellingwood). 

Therapeutics. — -Hewitt,  Cahill,  and  others  have  recommended 
the  drug  in  dental  therapeutics.  Some  enthusiasts  go  so  far  as  to 
recommend  the  use  of  the  drug  in  almost  every  disease  to  which  the 
body  is  heir. 

The  drug  has  been  used  in  acute  alveolar  abscess  to  prevent  the 
formation  of  pus,  or  after  pus-formation  to  hasten  its  evacuation.  In 
septicemia  (blood-poisoning),  it  is  claimed  to  be  almost  a  specific.  In 
ulcerative  stomatitis,  sore  throat  or  mouth  of  any  character,  the  local 
application  of  echafolta  is  prompt  and  effectual. 


CALX  SULPHURATA— U.  S.  P. 

(Sulphurated  Calcium;  Crude  Calcium  Sulphid.) 

Sulphurated  calcium  is  a  mixture  containing  at  least  60  per  cent, 
of  calcium  sulphid,  together  with  calcium  sulphate  and  varying  pro- 
portions of  carbon.  It  occurs  as  a  pale  gray  powder,  having  a  nause- 
ating, alkaline  taste  and  a  faint  odor  of  hydrogen  sulphid.  It  is  but 
slightly  soluble  in  water  and  insoluble  in  alcohol.  Exposure  to  air 
causes  gradual  decomposition.  The  dose  is  from  1/10-1/ 2  gr.  (0.006 
-0.03  gm.),  in  pills,  tablets,  or  capsules. 

Physiologic  Action  and  Therapeutics.— The  action  of  calcium 
sulphid  is  not  well  understood.  Its  power  of  preventing  and  arrest- 
ing suppuration  was  first  mentioned  by  Ringer.  It  has  been  found 
especially  useful  in  boils  and  carbuncles.  Excellent  results  are  obtained 
in  follicular  tonsillitis  and  quinsy  by  giving  small  doses  (1/20  gr.-o. 003 
gm.)  at  short  intervals.  Harlan  recommended  giving  the  drug  in 
doses  of  1/10  gr.  (0.006  gm.),  at  short  intervals,  in  acute  alveolar 
abscess  and  other  suppurative  conditions,  claiming  that  it  prevented 
the  formation  of  pus.  if  given  early  enough,  or,  if  too  late  for  this,  that 
the  agent  hastened  the  evacuation  of  the  pus.  Only  fresh  prepa- 
rations should  be  employed  on  account  of  the  liability  of  the  drug 
to  deteriorate. 


194  DIGESTANTS. 

AURI  ET  SODII  CHLORIDUM— U.  S.  P. 

(Gold  and  Sodium  Chlorid;  AuCl3 +NaCl.) 

This  preparation  is  a  mixture  of  equal  parts,  by  weight,  of  dry 
gold  chlorid  and  sodium  chlorid.  It  is  an  orange-yellow  powder, 
deliquescent,  and  of  a  saline  and  metallic  taste;  freely  soluble  in  water. 
The  dose  is  from  1/ 20-1/4  gr.  (0.003-0.016  gm.),  in  pill. 

Physiologic  Action  and  Therapeutics. — Gold  and  sodium 
chlorid  is  supposed  to  act  as  an  alterative,  tonic,  and  stimulant  to  the 
digestive  system.  It  has  been  recommended  in  a  number  of  diseases 
where  an  alterative  and  tonic  effect  is  desired,  but  it  is  of  doubtful 
value.  Solutions  of  gold  chlorid  have  been  recommended  by  Ames 
with  which  to  cauterize  exposed  sensitive  cementum,  claiming  its 
effect  is  nearly  equal  to  that  of  silver  nitrate  without  the  discoloration. 

DIGESTANTS. 

The  mouth  and  the  stomach  are  intimately  connected  and  closely 
related;  so  much  so  that  pathologic  conditions  in  one  often  predispose 
to  disease  in  the  other.  It  is  therefore  important  that  the  dentist  be 
familiar  with  the  action  and  uses  of  certain  agents  which  materially 
assist  in  the  digestion  of  food.  Those  not  discussed  under  other 
headings  will  here  be  considered.     They  are: 

Pepsin.  Malt. 

Pancreatin.  Papain. 

PEPSINUM— U.  S.  P. 

(Pepsin.) 

Pepsin  is  a  proteolytic  ferment  or  enzyme  obtained  from  the 
glandular  layer  of  fresh  stomachs  from  healthy  pigs.  It  occurs  as  a 
yellowish-white,  amorphous  powder,  or  thin,  pale  yellow  scales, 
having  a  faint  odor  and  a  slightly  acidulous  or  saline  taste.  It  is 
soluble  in  50  parts  of  water,  more  so  in  water  acidulated  with  hydro- 
chloric acid,  and  insoluble  in  alcohol.  The  Pharmacopeia  of  the 
United  States  requires  the  drug  to  be  capable  of  digesting  not  less 
than  3,000  times  its  weight  of  freshly  coagulated  and  disintegrated 
egg  albumin.     The  dose  is  from  5-20  gr.  (0.3-1.3  gm.). 

Physiologic  Action  and  Therapeutics. — Pepsin  is  an  excellent 
digestive,  being  a  normal  constituent  of  the  gastric  juice,  and  in  the 
presence  of  hydrochloric  acid  (a  natural  acid  of  the  stomach)  it 
digests  the  proteid  elements  of  the  food,  converting  these  insoluble 
substances  into  albumoses,  and  finally  into  soluble  peptones.     The 


PANCREATINUM — MALTUM.  195 

drug  is  given  in  cases  where  there  is  a  lessened  secretion  of  gastric 
juice,  as  in  atonic  dyspepsia,  cancer  of  the  stomach,  and  gastric  ulcer. 
Many  organic  acids,  alcohol,  and  alkalies  impair  the  proteolytic  action 
of  pepsin. 


PANCREATINUM— U.   S.  P. 

(Pancrcatin.) 

Pancreatin  is  a  mixture  of  enzymes  naturally  existing  in  the 
pancreas  of  warm-blooded  animals,  and  is  obtained  from  the  fresh 
pancreas  of  the  hog  or  the  ox.  It  consists  principally  of  amylopsin, 
myopsin,  trypsin,  and  steapsm.  To  be  up  to  the  official  standard  it 
should  be  capable  of  converting  not  less  than  25  times  its  weight  of 
starch  into  water-soluble  substance  (dextrose).  It  occurs  as  a  cream- 
colored  powder,  slowly  but  not  completely  soluble  in  water,  insoluble 
in  alcohol.     The  dose  is  from  5-20  gr.  (0.3-1.3  gm.). 

Physiologic  Action  and  Therapeutics. — The  action  of  pan- 
creatin is  due  to  the  active  enzymes  which  it  contains,  of  which  trypsin 
digests  proteids,  amylopsin  acts  upon  starches,  and  steapsin  emulsifies 
fats  and  oils,  resolving  them  into  fatty  acids  and  glycerin.  The  drug, 
like  pepsin,  is  used  as  an  artificial  digestant  in  certain  disorders  of  the 
stomach  wherein  digestion  is  impaired. 


MALTUM— U.  S.  P. 

(Malt.) 

Malt  is  the  grain  of  barley,  Hordeum  distichon,  partially  germinated 
artificially,  and  then  dried.     The  extract  is  official: 

Extractum  Malti,  U.  S.  P.     Dose,  4  fl.  dr.  (15.0  c.c). 
Fluidextractum  Malti,  N.  F.  (contains  25  per  cent.  vol.  alcohol). 
Dose,  2  fl.  dr.  (8.0  c.c). 

If  the  extract  of  malt  is  prepared  according  to  the  process  of  the 
United  States  Pharmacopeia,  the  fresh  preparation  will  contain  diastase, 
an  efficient  ferment  and  capable  of  converting  starch  into  dextrose. 
The  diastatic  power  rapidly  deteriorates  on  keeping.  The  extracts  of 
malt  are  extensively  used  as  digestants  and  as  general  tonics,  but  their 
value  is  more  or  less  questionable,  probably  on  account  of  the  difficulty 
of  obtaining  the  preparation  fresh  and  properly  prepared.  Heat 
above  570  C.  (1350  F.)  destroys  the  diastase. 


196  CATHARTICS. 

PAPAYOTIN— Unofficial. 

(Papain;    Papoid;    Caroid.) 

Papain  is  a  natural  albuminous  ferment  obtained  from  Carica 
papaya,  the  papaw  tree,  growing  in  the  tropics.  It  occurs  as  a  grayish- 
white,  amorphous  powder,  without  odor  or  taste.  It  is  soluble  in 
water  and  glycerin,  but  insoluble  in  alcohol  and  ether.  The  dose  is 
from  5-10  gr.  (0.3-0.6  gm.). 

Physiologic  Action  and  Therapeutics. — It  is  claimed  that 
papain  will  convert  proteids  into  peptones,  starch  into  maltose,  and 
emulsify  fats;  and  that  although  it  will  act  in  neutral  or  acid  solutions, 
it  is  most  active  in  solutions  of  an  alkaline  reaction  (Stevens) .  Harlan 
introduced  the  drug  in  dental  therapeutics  for  digesting  pulp  tissue 
after  devitalization.  He  suggested  making  a  paste  with  glycerin, 
acidulating  with  one  or  two  minims  of  a  1 :  500  solution  of  hydrochloric 
acid.  The  pulp  was  devitalized  in  the  usual  way,  and  this  paste  sealed 
in  contact  with  the  dead  tissue  for  one  or  two  weeks,  when  the  tissue 
was  supposed  to  be  liquefied.  Clinical  experience  with  the  drug  in 
dental,  as  well  as  in  general  therapeutics,  proves  it  of  doubtful  value. 

CATHARTICS. 

Cathartics  have  been  elsewhere  defined  as  agents  which  produce 
evacuation  of  the  bowels.  The  drugs  having  this  property  are  classified 
according  to  the  intensity  of  their  action  and  the  character  of  the  stool 
thus  produced.  Those  that  are  mild  in  action  and  produce  a  nearly 
normal  stool  are  called  laxatives.  Those  more  powerful,  usually 
producing  more  copious  stools  are  termed  purgatives.  Those  which 
produce  a  watery  evacuation  of  the  bowels  are  called  hydragogues. 
Those  which  gripe,  having  a  violent  action,  and  in  overdoses  produce 
symptoms  of  acute  enteritis  are  termed  drastics. 

The  chief  laxatives  are: 

Cascara  Sagrada.  Figs. 

Tamarind.  Prunes. 

Manna.  Hone)'. 

The  chief  purgatives  are: 

Aloes.  Rhubarb. 

Senna.  Calomel.* 

Castor  Oil.  Blue  Mass.* 
Sulphur. 


RJBAMNUS    PURSHIANA — TAMARINDUS.  197 

The  principal  hydragogues  are: 

Magnesium  Sulphate.  Sodium  Phosphate. 

Sodium  Sulphate.  nesium  Citrate. 

Potassium  and  Sodium  Tartrate. 

The  main  drastics  arc: 

Croton  Oil.  Gamboge. 

Colocynth.  Jalap. 

Podophyllum. 

RHAMNUS  PURSHIANA— U.  S.  P. 
(Cascara  Sagrada;  Chittem  Bark.) 

Cascara  sagrada  is  the  dried  bark  of  Rhamnus  purshiana,  a  small 
tree  growing  along  the  Pacific  coast  of  North  America.  It  contains  a 
crystalline  glucosid,  purshianin,  that  is  several  times  as  active  as  the 
crude  drug.  The  dose  of  cascara  sagrada  bark  is  from  30-60  gr. 
(2.0-4.0  gm.).     The  following  preparations  are  official: 

Fluidextractum    Rhamnus   Purshianae,  U.  S.  P.     Dose,    10-30 

min.  (0.6-2.0  c.c). 

Fluidextractum    Rhamnus   Purshianae   Aramaticum,    U.   S.  P. 

Dose,  10-30  min.  (0.6-2.0  c.c). 

Extractum  Rhamnus  Purshianae,  U.  S.  P.     Dose,  2-8  gr.  (0.13- 

0.5  gm.). 

Physiologic  Action  and  Therapeutics. — Cascara  sagrada  is  a 
peculiarly  efficient  laxative.  Its  action  is  somewhat  slow  and  is 
seldom  accompanied  with  irritation  or  unpleasant  symptoms.  It  is 
used  exclusively  as  a  tonic  laxative,  and  in  habitual  constipation  it  is  a 
reliable  remedy.  The  drug  possesses  a  distinct  advantage  over  many 
cathartics  in  not  readily  losing  its  effect  when  frequently  taken;  in  fact, 
in  most  cases  the  dose  can  be  diminished  gradually,  and  this  is  usually 
the  most  satisfactory  way  of  administering  the  remedy.  On  account 
of  the  unpleasant  bitter  taste  the  aromatic  fluid  extract  is  the  best 
preparation  to  use. 

TAMARINDUS— U.  S.  P. 
(Tamarind.) 

Tamarind  is  the  preserved  pulp  of  the  fruit  of  Tamarindus  iudica, 
a  large  tree  indigenous  to  Africa  and  cultivated  in  the  West  Indies.  It 
is  a  gentle  laxative  about  equal  in  power  to  the  fig  and  prune.  Its 
action  is  due  chiefly  to  the  potassium  salts  of  tartaric,  citric,  malic,  and 
acetic  acids,  of  which  it  contains  from  8-12  per  cent.     The  dose  is 


I98  CATHARTICS. 

from  1-8  dr.  (4.0-32.0  gm.).     It  is  a  constituent  of  the  only  official 
confection  of  senna. 

MANNA— U.  S.  P. 

Manna  is  a  concrete  saccharine  exudation  from  Fraxinus  ornus,  a 
small  native  tree  of  Sicily  and  other  Mediterranean  islands.  Its  chief 
constituent  is  mannite  (50-80  per  cent.)  a  sweet  crystalline  principle, 
soluble  in  water.  It  acts  as  a  mild  laxative  in  doses  of  1-2  oz.  (32.0- 
64.0  gm.).  It  is  usually  given  in  combination  with  other  cathartics, 
and  is  a  constituent  of  the  compound  infusion  of  senna. 

FICUS— U.  S.  P. 

(Fig.) 

Fig  is  the  dried  fruit  of  Ficus  carica,  a  native  tree  of  the  shores  of 
Levant,  but  cultivated  in  tropical  countries.  It  contains  about  62 
per  cent,  of  grape-sugar,  also  gum,  fat,  etc.  It  acts  as  a  demulcent  and 
laxative,  and  is  a  constituent  of  the  official  confection  of  senna.  Figs 
are  chiefly  used  as  an  article  of  diet  in  habitual  constipation. 

PRUNUM— U.  S.  P. 

(Prune.) 

Prune  is  the  dried  fruit  of  Prunus  domestica,  the  plum  tree,  in- 
digenous to  western  Asia,  but  cultivated  in  most  temperate  countries. 
It  contains  sugar,  pectin,  albumin,  malic  acid,  and  salts.  Prunes  are 
laxative  and  nutritious,  and  are  freely  used  as  food  and  sweetmeat. 
Stewed  prunes  are  an  excellent  remedy  for  constipation  in  children. 
They  are  a  constituent  of  the  confection  of  senna. 

MEL— U.  S.  P. 

(Honey.) 

Honey  is  a  saccharine  secretion  deposited  in  the  honey-comb  by 
Apis  mellifica,  the  honey-bee.  It  is  a  strong  aqueous  solution  of  several 
sugars  (cane-  and  grape-sugar,  levulose)  with  wax  pollen,  coloring  and 
odorous  matters,  etc.  Honey  is  often  adulterated  with  starch  and 
glucose.  The  dose  is  indefinite.  Clarified  honey  is  official  (Mel 
Despumatum,  U.  S.  P.),  and  is  an  ingredient  of  confection  of  senna  and  of 
the  official  honey  of  rose  (Mel  Rosoe.  U.  S.  P.).  Honey  is  a  laxative, 
nutritive,  and  emollient.  It  is  used  chiefly  as  an  emollient  in  diseases 
of  the  throat  to  relieve  dryness,  pain,  cough,  and  dysphagia,  and  also  as  a 


ALOE.  I99 

pleasant  vehicle  for  certain  nauseous  drugs.  Honey  of  rose  is 
slightly  astringent,  and  is  used  in  gargles,  sprays,  or  washes  for  inflam- 
matory and  ulcerating  conditions  of  the  mucous  membrane  of  the 
mouth,  throat,  and  nasal  passages.  The  wax  obtained  from  the 
honey-comb  is  a  useful  material  in  dental  practice. 

ALOE— U.  S.  P. 

(Aloes.) 

Aloes  is  the  inspissated  juice  obtained  from  the  leaves  of  several 
species  of  genus  Aloe,  a  familiar  example  of  which  is  the  American 
century  plant.  It  grows  abundantly  in  nearly  all  hot,  dry  countries. 
Two  varieties  were  formerly  recognized  by  the  United  States  Pharmaco- 
peia (1890):  Barbadoes  aloes  (Aloe  barb  ad  en  sis),  obtained  from 
Aloe  vera,  and  Socotrine  aloes  (Aloe  socotrina),  obtained  from  Aloe 
perryi.  The  chief  constituent  is  aloin,  also  official,  a  neutral  crystalline 
principle,  and  from  which  is  obtained  emodin,  a  glucosid  to  which  the 
purgative  property  of  the  drug  is  doubtless  due.  Emodin  is  also  found 
in  senna  and  rhubarb.  The  dose  of  aloes  is  from  1-10  gr.  (0.065- 
0.65  gm.).     The  following  preparations  are  official: 

Aloninum,  U.  S.  P.     Dose,  1/4-2  gr.  (0.016-0. 13  gm.). 
Aloe  Purificatum,  U.  S.  P.     Dose,  1-10  gr.  (0.065-0.65  gm.). 
Tinctura  Aloes,  U.  S.  P.     Dose,  1/2-2  fl.  dr.  (2.0-8.0  c.c). 
Tinctura  Aloes  et  Myrrhae,  U.  S.  P.  (contains  10  per  cent,  of  each, 
with  Licorice).     Dose,  1/2-2  fl.  dr.  (2.0-8.0  c.c). 
Piluke  Aloes,  U.  S.  P.  (contains  about  2  gr.-0.13  gm-)-     Dose, 
1-5  pills. 

Pilulae  Aloes  et  Asafcetidae,  U.  S.  P.  (contains  about  1  1/3  gr.-o .  08 
gm.  of  each).     Dose,  1-5  pills. 

Pilulae  Aloes  et  Ferri,  U.  S.  P.  (contains  about  1  gr.-o. 065  gm.- 
each  of  Aloes  and  Ferrous  Sulphate).     Dose,  1-3  pills. 
Pilulae  Aloes  et  Mastiches,  U.  S.  P.  (Lady  Webster's  pills;  con- 
tains about  2  gr.  0.13  gm.  of  Aloes,  with   Mastich   and   Red 
Rose).     Dose,  1-5  pills. 

Pilulae  Aloes  et  Myrrhae,  U.  S.  P.  (contains  Aloes,  2  gr.-o.  13  gm.; 
Myrrh,  1  gr.-o. 06  gm.).     Dose,  1-4  pills. 

Pilulae  Rhei  Compositae,  U.  S.  P.  (contains  Aloes,  1  1/2  gr.-o.  1 
gm.;  Rhubarb,  2  gr.-o. 13  gm.;  Myrrh  and  Oil  of  Peppermint). 
Dose,  1-5  pills. 

The  drug  enters  into  other  official  preparations,  as  compound 
extract  of  colocynth,  compound  tincture  of  benzoin,  compound  cathar- 
tic pills,  and  other  vegetable  cathartic  pills. 

Physiologic  Action  and  Therapeutics. — Aloes  is  a  rather  slowly 
acting  but  effective  purgative.     As  will  be  noticed  from  the  list  of  prep- 


200  CATHARTICS. 

arations,  that  aloes  is  rarely  used  singly  as  a  cathartic.  In  simple, 
persistent  constipation,  it  may  be  combined  advantageously  with  other 
drugs,  nux  vomica,  ipecac,  rhubarb,  or  podophyllum.  Pills  of  aloes 
and  iron  are  often  given  with  benefit  in  chlorosis  with  constipation. 
The  liquid  preparations  have  a  disagreeable  taste  which  is  difficult  to 
mask  and  are  rarely  given.  The  pill  is  the  popular  form  of  administer- 
ing the  drug. 

SENNA— U.  S.  P. 

Senna  is  the  leaflets  of  Cassia  acutifolia  and  Cassia  angustifolia, 
small  shrubs  growing,  respectively,  in  Africa  and  India.  It  contains 
chiefly  an  active  acid  glucosid,  cathartin  or  cathartinic  acid,  also  emodin. 
The  dose  is  from  1-3  dr.  (4.0-12.0  gm.).  The  following  preparations 
are  official: 

Fluidextractum  Sennae,  U.  S.  P.     Dose,  1-2   fl.    dr.    (4.0-8.0 

c.c). 

Syrupus  Sennae,  U.  S.  P.  (25  per  cent.).     Dose,  1-4  fl.  dr.  (4.0- 

15.0  c.c). 
Infusum  Sennae  Compositum,  U.  S.  P.  (Black  Draft:  Senna,  6; 
Fennel,  2;  Manna,  12;  Epsom  Salts,  12).     Dose,  1-4  fl.  oz.  (30.0 
-120.0  c.c). 

Confectio  Sennae,  U.  S.  P.  (10  per  cent.,  with  Cassia  Fistula, 
Tamarind,  Prune,  Fig,  Sugar,  and  Coriander  Oil).  Dose,  1-2  dr. 
(4.0-8.0  gm.). 

Pulvis  Glycyrrhizae  Compositus,  U.  S.  P.  (18  per  cent,  of  Senna, 
with  Licorice,  Sulphur,  Sugar,  and  Fennel  Oil).  Dose,  1/2-2  dr. 
(2.0-8.0  gm.). 

Extract  of  senna  (1.5  per  cent.)  is  a  constituent  of  compound 
syrups  of  sarsaparilla. 

Physiologic  Action  and  Therapeutics. — Senna  acts  energetic- 
ally as  a  purgative.  Its  action  is  more  irritating  than  that  of  rhubarb 
and  more  prompt  and  powerful  than  that  of  aloes.  It  is  one  of  the 
best  vegetable  purgatives,  and  its  effect  is  certain  and  reliable  in 
simple,  acute  constipation.  In  habitual  costiveness,  compound  licorice 
powder  is  a  popular  household  remedy.  It  is  given  at  bedtime  in 
about  a  teaspoonful  dose,  governed  by  the  age  of  the  patient. 

OLEUM  RICINI— U.  S.  P. 

(Castor  Oil.). 

Castor  oil  is  a  fixed  oil  expressed  from  the  seed  of  Ricinus  com- 
munis, a  plant  indigenous  to  India,  but  cultivated  in  many  other 
temperate  countries.     It  occurs  as  a  pale  yellow,  viscid  oil,  having  a 


Rill   I    \1.  20I 

faint  odor  unci  a  slightly  acrid,  offensive  taste.  It  is  freely  soluble  in 
alcohol.     It  contains  the  glyceric!  of  ricinoleic  acid,  called  ricinolein, 

and  to  which  the  purgative  property  of  the  drug  is  due.  The  dose  of 
castor  oil  is  from  i  fl.  dr.-i  fl.  oz.  (4.0-30.0  c.c),  governed  by  the  age  of 
the  patient. 

Physiologic  Action  and  Therapeutics. — Castor  oil  is  a  mild  but 
thorough  purgative.  Stevens'  states  that  while  its  fate  in  the  body  has 
not  been  definitely  determined,  it  is  probable  that  it  escapes  from  the 
stomach  unchanged,  and  that  in  the  presence  of  the  alkaline  juices  of 
the  intestines  saponification  occurs  with  the  liberation  of  ricinoleic 
acid,  which  is  subsequently  converted  into  ricinoleates.  The  latter 
induce  catharsis  by  stimulating  the  muscular  coat  of  the  bowel,  and  are 
probably  absorbed,  since  the  oil  is  known  to  impart  its  purgative  proper- 
ties to  the  milk  when  given  to  nursing  women. 

Castor  oil  has  long  been  a  household  remedy  to  remove  irritant 
material  from  the  bowel  in  the  beginning  of  acute  inflammatory  diarrhea, 
especially  in  children.  It  is  not  a  suitable  remedy  for  habitual  consti- 
pation, as  is  generally  supposed  by  the  laity.  The  drug  is  a  desirable 
constituent  of  many  lotions,  used  on  the  scalp  for  dandruff,  etc.,  owing 
to  its  solubility  in  alcohol. 

Patrick,  Moyer,  and  other  neurologists  highly  recommend  large 
doses  of  castor  oil  in  tic  douloureux.  Smaller  doses  are  first  admin- 
istered, and  gradually  increased  until  large  quantities  may  be  taken 
daily  without  inducing  catharsis. 

The  main  objection  to  castor  oil  as  a  therapeutic  agent  is  its 
disagreeable  taste.  Many  substances  have  been  suggested  to  over- 
come this  objection,  among  which  may  be  mentioned  the  oils  of  pepper- 
mint, gaultheria,  and  cinnamon.     A  pleasant  combination  follows: 

Castor  Oil,  8  oz.  (240.0  c.c);  Oil  of  Peppermint,  5  min.  (0.3 
c.c);  Saccharin,  2  gr.  (0.13  gm.);  and  Alcohol,  1  dr.  (4.0  c.c). 
The  Oil  of  Peppermint  and  Saccharin  should  first  be  dissolved  in 
Alcohol  and  then  added  to  the  Castor  Oil.  The  usual  dose  may 
be  given. 

Castor  Oil  may  also  be  given  in  flexible  capsules. 

RHEUM— U.  S.  P. 

(Rhubarb.) 

Rhubarb  is  the  root  of  Rheum  officinale,  a  perennial  herb  resem- 
bling garden  rhubarb,  but  of  larger  growth,  and  a  native  of  China, 
Thibet,  and  other  Asiatic  countries.     It  contains  chrysophanic  acid, 

1  Modern  Materia  Medica  and  Therapeutics. 


202  CATHARTICS. 

emodin,  tannic  acid,  and  several  resinous  principles.  It  is  to  emodin 
and  possibly  some  of  the  resinous  principles  that  rhubarb  owes  its 
purgative  properties,  for  chrysophanic  acid  has  no  purgative  action 
and  tannic  acid  is  an  astringent.  The  dose  of  rhubarb  is  from  5-30  gr. 
(0.3-2.0  gm.).     The  following  preparations  are  official: 

Tinctura  Rhei,  U.  S.  P.  (10  per  cent.,  with  Cardamom).     Dose, 

1-2  fl.  dr.  (4.0-8.0  c.c). 

Tinctura  Rhei  Aromatica,  U.  S.  P.  (20  per  cent.,  with  Aromatics). 

Dose,  1/2-1  fl.  dr.  (2.0-4.0  c.c). 

Tinctura  Rhei  Dulcis,  U.  S.  P.   (10  per  cent.,  with  Licorice, 

Anise,  and  Cardamom).     Dose,  1-2  fl.  dr.  (4.0-8.0  c.c). 

Fluidextractum  Rhei,  U.  S.  P.     Dose,  10-30  min.  (0.6-2.0  c.c). 

Extractum  Rhei,  U.  S.  P.     Dose,  5-10  gr.  (0.3-0.6  gm.). 

Mistura  Rhei  et  Sodae,  U.  S.  P.   (15  per  cent.,  with  Sodium 

Bicarbonate,  fluid  extract  of  Ipecac,  and  spirit  of  Peppermint). 

Dose,  1/2-2  fl.  dr.  (2.0-8.0  c.c). 

Syrupus    Rhei,   U.   S.  P.   (10    per  cent,  of   the  fluid  extract). 

Dose,  1-6  fl.  dr.  (4.0-22  .5  c.c). 

Syrupus  Rhei  Aromaticus,  U.  S.  P.  (15  per  cent,  of  aromatic 

tincture    and    spiced    syrup  of    Rhubarb).     Dose,   1-6  fl.   dr. 

(4.0-22.5  c.c). 

Pulvis  Rhei  Compositus,  U.  S.  P.  (Gregory's  Powder:  Rhubarb, 

25;  Magnesia,  65;  Ginger,  10).     Dose,  20-60  gr.  (1.3-4.0  gm.). 

Pilulae  Rhei,  U.  S.  P.  (3  gr.-o.2  gm.  each).     Dose,  1-5  pills. 

Pilulae  Rhei  Compositus,  U.  S.  P.     Dose,  1-5  pills. 

Physiologic  Action  and  Therapeutics. — Rhubarb  acts,  in 
appropriate  doses,  as  a  purgative  and  stomachic.  As  a  secondary 
effect,  however,  it  frequently  causes  constipation,  due  to  the  tannic 
acid  it  contains.  Doses  of  from  1-3  gr.  (0.06-0.2  gm.)  often  produce 
no  cathartic  action,  but  its  effect  upon  the  stomach  is  that  of  a  mild 
astringent  and  tonic. 

As  an  agent  for  removing  irritant  material  from  the  bowel  in  the 
beginning  of  acute  inflammatory  diarrhea,  especially  with  children, 
rhubarb  is  highly  efficient.  To  check  diarrhea  in  cholera  morbus 
the  following  has  long  been  a  popular  remedy:  tincture  of  rhubarb, 
tincture  of  capsicum,  tincture  of  opium,  spirit  of  camphor,  and  spirit 
of  peppermint — an  equal  quantity  of  each.  The  dose  is  from  15-30 
min.  (1.0-2.0  c.c),  in  water. 

SULPHUR. 

(S.) 

The  element  sulphur  is  recognized  by  the  United  States  Pharmaco- 
peia in  three  forms-. 


cent.)     Also, 


SULPHUR — MAGNESII    SULPHAS.  203 

Sulphur  Sublimatum — U.  S.  P.  (Sublimed  Sulphur;  Flowers 
of  Sulphur). — This  occurs  as  a  fine  yellow  powder,  having  a  slightly 
characteristic  odor  and  a  faintly  acid  taste.  It  is  insoluble  in  water, 
partially  soluble  in  absolute  alcohol,  ether,  and  chloroform.  The  dose 
is  from  10-120  gr.  (0.6-8.0  gm.). 

Sulphur  Lotum-  U.  S.  P.  (Washed  Sulphur). — This  form  of 
sulphur  is  prepared  by  digesting  sublimed  sulphur  for  three  days 
in  weak  ammonia  water,  and  then  washing.  It  enters  into  two  official 
preparations: 

Unguentum  Sulphuris,  U.  S.  P.  (15  per  cent.). 
Pulvis  Glycyrrhizae  Compositus,  U.  S.  P.  (8  per 
Unguentum  Sulphuris  Compositum,  N.  F. 

Sulphur  Praecipitatum— U.  S.  P.  (Precipitated  Sulphur;  Milk  of 
Sulphur). — This  is  a  fine,  almost  white  powder,  without  odor  or  taste. 
It  is  prepared  by  precipitation  from  calcium  sulphid  solutions  with  di- 
luted hydrochloric  acid.     The  dose  is  from  10-120  gr.  (0.6-8.0  gm.). 

Physiologic  Action  and  Therapeutics. — Sulphur  acts  locally 
as  a  stimulant  and  parasiticide.  Internally,  it  acts  as  a  mild  purgative. 
As  a  stimulating  remedy  it  has  been  recommended  in  pyorrhea  alveolaris 
but  its  use  is  of  doubtful  value.  It  is  a  reliable  remedy,  however,  in 
parasitic  diseases,  like  scabies  (itch)  and  ring-worm.  The  ointment  may 
be  employed.  The  drug  may  be  given  internally,  mixed  with  honey 
or  molasses,  as  a  laxative.  When  sulphur  is  burned  in  the  air,  sulphur 
dioxid  (S02)  is  formed.  This  acid-forming  oxid  (anhydrid)  unites 
with  water  to  form  sulphurous  acid  (H2S03),  which  latter  product  is 
a  potent  disinfectant  and  bleaching  agent.  Kirk  recommends  a  mix- 
ture of  boric  acid  and  sodium  sulphite  as  a  bleaching  agent  for  tooth- 
structure.  The  mixture  should  be  placed  in  the  cavity  dry,  then 
moistened  and  hermetically  sealed.  A  reaction  is  brought  about 
whereby  sulphurous  acid  is  formed. 

MAGNESII  SULPHAS— U.  S.  P. 

.Magnesium  Sulphate;   Epsom  Salt;   MgS04./H20.) 

Magnesium  sulphate  occurs  in  small,  colorless,  rhombic  prisms 
or  acicular  crystals,  without  odor,  and  having  a  cooling,  saline,  unpleas- 
ant, and  bitter  taste;  soluble  in  1.5  parts  of  water,  and  insoluble  in 
alcohol.  The  dose  is  from  1-8  dr.  (4.0-32.0  gm.).  There  is  one 
official  preparation: 

Magnesii  Sulphas  Effervescens,  U.  S.  P.  (contains  Magnesium 
Sulphate,  500;  Sodium  Bicarbonate,  403;  Tartaric  Acid,  211; 
Citric  Acid,  136)      Dose,  1-8  dr.  (4.0-32.0  gm.). 


204  CATHARTICS. 

Physiologic  Action. — Magnesium  sulphate  is  a  typical  represen- 
tative of  the  class  of  saline  cathartics,  all  of  which  produce  evacuation 
of  the  bowels  chiefly  by  increasing  the  amount  of  fluid  in  the  intestine. 
They  differ  in  their  action  from  vegetable  cathartics  in  that  they  stimu- 
late peristalsis  but  feebly.  They  not  only  hinder  the  absorption  of  fluid 
taken  with  the  food,  but  they  abstract  more  fluid  directly  from  the  tissues 
and  blood.  To  understand  thoroughly  this  so-called  salt  action — i.e., 
the  behavior  of  saline  solutions  of  varying  degrees  of  concentration 
in  relation  to  the  salinity  of  the  blood  serum,  by  which  a  flow  of  fluid 
to  or  from  the  blood  is  determined — it  is  necessary  that  we  be  familiar 
with  certain  physical  processes,  chief  among  which  is  that  of  osmosis — 
the  passage  of  salts  through  animal  membranes,  or  the  force  by  which 
fluids  are  impelled  through  organic  membranes.  If,  for  example,  a 
10  per  cent,  solution  of  common  salt  is  placed  in  the  bottom  of  a  con- 
tainer and  water  placed  in  the  top,  the  two  liquids  being  separated 
by  a  more  or  less  permeable  animal  membrane,  in  a  few  moments 
it  will  be  observed  that  the  specific  gravity  of  the  two  fluids  are  the 
same.  By  the  process  of  osmosis,  then,  the  salt  from  the  solution 
in  the  bottom  has  passed  through  the  membrane,  and  a  5  per  cent, 
solution  of  common  salt  on  both  sides  of  the  separating  medium  is 
the  result.  A  semipermeable  membrane  is  one  which  allows  the  passage 
of  one  sort  of  molecules  (usually  the  solvent),  while  impervious  to 
another  (usually  the  dissolved  substance).  The  interposition  of  such 
a  membrane  between  salt  solutions  of  varying  degrees  of  concentration 
introduces  very  important  modifications  in  the  osmotic  process,  and 
results  in  the  development  of  what  is  termed  osmotic  pressure.  The 
walls  of  the  intestines  are  only  partly  semipermeable;  i.e.,  they  are 
partly  permeable  to  salts,  though  much  less  readily  than  to  water. 
If  two  solutions  having  the  same  molecular  concentration  in  dissolved 
substance  (i.e.,  equimolecular)  are  separated  by  a  semipermeable 
membrane  impermeable  to  the  dissolved  substance,  it  is  evident  that 
no  change  of  liquid  will  occur.  Such  solutions,  having  the  same 
specific  gravity  and,  therefore,  the  same  osmotic  tension  or  pressure, 
are  called  isotonic  to  each  other.  In  physiologic  literature  "isotonic" 
usually  means  solutions  having  the  same  concentration  (specific  gravity) 
as  blood-serum,  and  it  is  in  this  sense  that  the  term  is  used  in  these 
pages.  If  one  solution  has  a  greater  concentration  than  the  other 
and  the  separating  medium  be  a  partly  semipermeable  membrane, 
like  the  walls  of  the  intestines,  water  principally  will  pass  from  the 
weaker  into  the  stronger  solution  until  both  have  the  same  concentra- 


M  \..\i.sn    SULPH  IS.  205 

tion.  The  stronger  solution  is  then  called  hyperisotonic;  the  weaker, 
hypoiso/cmic.     Both,  not  being  isotonic,  are  called  anisotonic. 

With  this  knowledge  of  salt  action  we  can  readily  understand 
how  saline  cathartics,  in  normal  subjects,  act  as  hydragoguo.  i.e., 
produce  a  watery  evacuation  of  the  bowels,  and  why  they  are  absorbed 
from  the  intestine  very  slowly  and  in  but  small  quantities,  the  greater 
portion  escaping  from  the  body  in  the  stools.  The  action  of  saline 
cathartics,  therefore,  is  purely  local,  which  fact  is  sustained  by  the 
further  fact  that  they  do  not  produce  catharsis  when  intravenously 
injected.  When  saline  cathartics  are  administered  to  an  anhydremic 
patient  (having  a  deficient  amount  of  water  in  the  blood)  the  process 
of  their  action  is  reversed;  instead  of  the  blood  in  the  adjacent  tissues 
yielding  its  water  to  the  intestine,  the  blood  abstracts  water  from  the 
bowel,  the  greater  portion  of  the  salt  is  absorbed,  and  purgation  does 
nof  ensue.  This  means  that  a  hypoisotonic  solution  of  the  salt  must 
necessarily  be  administered,  otherwise  this  result  would  not  follow. 
An  isotonic  or  perhaps  a  hyperisotonic  solution  with  a  normal  subject 
might  be  hypoisotonic  in  cases  of  anhydremia. 

Magnesium  sulphate  in  concentrated  solution  (hyperisotonic), 
is  an  active  hydragogue  cathartic,  producing  in  a  few  hours  a  copious 
watery  evacuation  of  the  bowel  without  much  pain  or  systemic 
disturbance.  Dilute  solutions  (hypoisotonic)  do  not  produce  purga- 
tion, but  the  salt  being  absorbed  in  greater  quantity,  they  act  as 
diuretics,  increasing  the  flow  of  urine. 

Therapeutics. — Magnesium  sulphate,  being  practically  free  from 
irritant  properties,  is  an  excellent  cathartic  for  removing  undigested 
material  from  the  bowel  in  acute  enteritis  and  colitis  (colic). 
Stevens  speaks  favorably  of  saline  cathartics  in  chronic  constipation, 
giving  a  small  dose  before  breakfast,  claiming  that  they  are  sometimes 
more  efficacious  than  vegetable  cathartics.  "While  vegetable  cathartics 
are-  usually  given  at  night  on  account  of  their  rather  slow  action, 
generally  causing  no  inconvenience  until  morning,  saline  cathartics  act 
more  promptly  and  powerfully  when  given  before  breakfast. 

Saline  cathartics  are  especially  indicated  in  acute  alveolar  abscess 
as  they  deplete  the  engorged  tissues,  preventing  stagnation  of  the  blood 
in  the  affected  part,  thus  aiding  nature  materially  in  preventing  the  in- 
fected tissues  from  being  broken  down  into  pus.  A  heaping  teaspoon- 
ful  of  Epsom  salt  may  be  dissolved  in  a  wineglass  half  full  of  warm 
water,  having  at  hand,  in  another  glass,  some  fresh  water.  By  drink- 
ing the  fresh  water  as  soon  as  the  concentrated  solution  is  taken, 
the  bitter  taste  of  the  drug  will  scarcely  be  noticed. 


206  CATHARTICS. 

Epsom  salt  is  also  used  in  phenol  poisoning,  and  in  acute  lead  poi- 
soning. With  phenol,  the  innocuous  phenol  sulphonate  is  formed,  and 
with  the  soluble  salts  of  lead  (acetate)  an  insoluble  sulphate. 

Incompatibles. — Magnesium  sulphate  is  incompatible  with  lead 
acetate  (sugar  of  lead),  silver  nitrate,  alkaline  carbonates,  and  lime- 
water. 

SODII  SULPHAS— U.  S.  P. 

(Sodium  Sulphate;   Glauber's  Salt;  Na2S04.ioH20.) 

Sodium  sulphate  occurs  in  large,  colorless,  transparent  prisms  or 
granular  crystals,  odorless,  and  having  a  bitter,  saline  taste.  It  is 
soluble  in  2.8  parts  of  water,  and  insoluble  in  alcohol.  The  dose  is 
from  2-8  dr.  (8.0-32.0  gm.). 

Physiologic  Action  and  Therapeutics. — Sodium  sulphate  acts 
as  a  powerful  hydragogue  cathartic,  producing  large  watery  stools. 
Its  action  is  accompanied  by  considerable  griping,  because  of  which 
Epsom  salt  has  largely  superseded  the  drug.  Sodium  sulphate  enters 
into  the  mixture  known  as  artificial  Carlsbad  salt,  which,  given  in  doses 
of  a  teaspoonful  in  a  glassful  of  hot  water  half  an  hour  before  break- 
fast, makes  an  efficient  mild  aperient.  The  formula  follows:  sodium 
sulphate,  5  oz.  (160.0  gm.);  sodium  bicarbonate,  2  oz.  (64.0  gm.); 
sodium  chlorid,  1  oz.  (32.0  gm.).  Both  sodium  and  magnesium  sul- 
phates are  active  ingredients  in  certain  natural  mineral  waters,  like 
Hunyadi  Janos,  Carlsbad,  etc.  These  waters  may  be  given  in  cases 
of  pyorrhea  alveolar  is  associated  with  rheumatism  or  gout. 

SODII  PHOSPHAS— U.  S.  P. 

(Sodium  Phosphate;  Na2HP04.i2H20.) 

Sodium  phosphate  occurs  in  large,  colorless,  prismatic  crystals, 
without  odor,  but  having  a  cooling,  saline  taste.  It  is  soluble  in  5.5 
parts  of  water,  and  insoluble  in  alcohol.  The  dose  is  from  1  gr.~4  dr. 
(0.06-16.0  gm.),  depending  on  the  age  of  the  patient.  For  a  young 
child  a  small  amount  only  is  necessary.  The  following  preparations 
are  official: 

Sodii  Phosphas  Effervescens,  U.  S.  P.     Dose,  1-8  dr.  (4.0-32.0 

gm.). 

Sodii  Phosphas  Exsiccatus,  U.  S.  P.     Dose,  10-60  gr.  (0.6-4.0 

gm.). 

Liquor  Sodii  Phosphatis   Compositus,   U.   S.  P.   (each  fl.   dr. 

(4.0  c.c.)  contains  1  dr.  (4.0  gm.)  of  Sodium  Phosphate,  with 

Sodium  Nitrate  and  Citric  Acid).     Dose,  1-3  fl.  dr.  (4.0-12.0 

c.c). 


MAGNESII   CITRAS — POTASSII   ET   SODII   TARTRAS.  207 

Physiologic  Action  and  Therapeutics. — The  manner  of  action 
of  sodium  phosphate  depends  upon  the  quantity  administered.  In 
small  doses  it  acts  as  a  laxative;  in  large  doses,  as  a  purgative.  Its 
mild  action  and  agreeable  taste  especially  commend  it  for  children, 
to  whom  the  proper  doses  may  be  given  in  milk  or  other  liquid  food. 
Stevens  speaks  favorably  of  the  drug,  given  in  small  doses  in  hot  water 
before  breakfast,  in  chronic  gastric  catarrh  with  constipation,  also  in 
simple  catarrhal  jaundice. 

MAGNESII  CITRAS— Unofficial. 

(Magnesium  Citrate;  Mg3(C6Hs07)a.i4HaO.) 

Magnesium  citrate  is  obtained  by  dissolving  magnesium  car- 
bonate in  citric  acid.  It  is  a  colorless  substance,  easily  soluble  in 
water.     It  is  only  official  in  the  form  of  solution  of  magnesium  citrate. 

Liquor  Magnesii  Citratis,  U.  S.  P  Dose,  6-12  fl.  oz.  (180.0- 
360.0  c.c). 

In  cases  of  acute  alveolar  abscess  where  it  is  desired  to  administer  a 
saline  cathartic,  this  solution  is  highly  efficacious.  It  is  well  tolerated 
by  the  stomach,  and  its  action  is  effective.  It  is  somewhat  irritating, 
and  should  not  be  administered  when  there  is  any  inflammation  of  the 
gastrointestinal  tract.  An  effervescent  salt  of  magnesium  citrate  may 
be  obtained  from  the  pharmacies. 

POTASSII  ET  SODII  TARTRAS— U.  S.  P. 

(Potassium  and  Sodium  Tartrate;  Rochelle  Salt;  KNaC4H406.  4H20.) 

Rochelle  salt  occurs  in  colorless,  transparent,  prismatic  crystals, 
or  as  a  white  powder,  without  odor,  but  having  a  cooling,  saline  taste; 
soluble  in  about  1  part  of  water.  The  dose  is  from  2-4  dr.  (8.0-16.0 
gm.).  It  is  an  essential  constituent  of  the  official  compound  efferves- 
cent powder. 

Pulvis  Effervescens  Compositus,  U.  S.  P.  (Seidlitz  Powder). 
Dose,  1  powder. 

A  dose  of  Seidlitz  powder  is  contained  in  two  different  colored 
papers — one  blue,  the  other  white.  The  blue  paper  contains 
Potassium  and  Sodium  Tartrate,  120  gr.  (8.0  gm.);  and 
Sodium  Bicarbonate,  40  gr.  (2.6  gm.).  The  white  paper 
contains  Tartaric  Acid,  35  gr.  (2.3  gm.).  The  contents  of  each 
paper  should  be  dissolved  separately,  the  two  solutions  mixed, 
and  the  whole  taken  while  effervescence  is  taking  place. 


2o8  CATHARTICS. 

Physiologic  Action  and  Therapeutics. — Rochelle  salt  may  be 
given  as  a  hydragogue  cathartic  in  the  same  classes  of  cases  that 
magnesium  sulphate  was  recommended.  Its  administration  is  more 
agreeable  than  the  latter,  but  its  action  is  less  active.  The  carbonic 
acid  evolved  during  the  effervescence  of  a  Seidlitz  powder  exerts  a  more 
or  less  sedative  influence  on  the  stomach,  as  well  as  making  the  solu- 
tion more  palatable.  As  a  mild  saline  cathartic,  especially  during  the 
summer  season,  a  dose  of  Seidlitz  powder  is  highly  efficacious. 


OLEUM  TIGLII— U.  S.  P. 

(Croton    Oil.) 

Croton  oil  is  a  fixed  oil  expressed  from  the  seeds  of  Croton  tiglium, 
a  small  native  tree  of  China,  but  extensively  cultivated  in  India  and 
the  Philippine  Islands.  It  occurs  as  a  yellowish,  viscid  oil,  having  a 
faint  odor  and  an  acrid,  burning  taste.  It  contains  croton-oleic  acid, 
both  free  and  as  a  glycerid,  together  with  several  other  inactive  fatty 
acids.     The  dose  of  croton  oil  is  from  1/2-2  min.  (0.03-0.13  c.c). 

Physiologic  Action  and  Therapeutics.— Croton  oil  is  a  violent 
irritant.  When  applied,  undiluted,  to  the  skin  it  causes  redness  and 
burning,  followed  by  a  copious  eruption  of  pustules.  When  internally 
administered  it  acts  as  a  powerful  drastic  cathartic,  causing  in  one  or 
two  hours  several  copious  movements  of  the  bowels,  attended  with 
considerable  pain,  and  sometimes  with  nausea.  Large  doses  produce 
all  the  symptoms  of  a  severe  gastroenteritis — burning  sensation  in 
stomach,  pain,  etc.  On  account  of  the  ease  with  which  it  may  be  admin- 
istered (small  quantities  being  so  effectual)  the  drug  is  a  convenient 
cathartic  to  give  in  cases  where  the  patient  can  swallow  only  with 
difficulty.  It  may  be  taken  in  a  small  amount  of  olive  oil  or  in  a  pill 
with  bread-crumbs  as  an  excipient.  The  prompt  irritant  action  of 
croton  oil  on  the  bowel  makes  it  a  useful  revulsant  in  cases  of  cerebral 
congestion;  therefore,  its  effect  is  advantageous  in  uremia,  apoplexy, 
and  acute  mania.  In  cases  like  lead  poisoning,  where  obstinate  consti- 
pation is  a  concomitant,  the  drug  is  especially  useful. 

Croton  oil  may  be  mixed  with  some  indifferent  oil  (croton  oil, 
1  part;  olive  oil,  7  parts)  and  used  as  a  dental  counterirritant.  It 
has  no  advantage  here,  however,  over  the  more  generally  used  counter- 
irritants  (iodin,  mustard,  capsicum,  etc.).  Stevens  speaks  favorably 
of  a  mixture  of  croton  oil  (1  part)  and  tincture  of  iodin  (2  parts)  to 
be  used  as  a  pigment  in  neuritis. 


COLYCYNTHIS      <  AMBOGIA — JALAPA.  209 

COLYCYNTHIS     U.  S.  P. 
Colycynth.) 

Colycynth  is  the  fruit  of  Citruttus  colocynthis   deprived  of  its 

rind.  The  plant  grows  in  arid  places  in  Asia,  Africa,  and  southern 
Europe.  It  contains  colocynthin,  a  bitter  glucosid,  to  which  its  ca- 
thartic property  is  largely  due.  The  dose  of  colocynth  is  1  gr.  (0.06 
The  following  preparations  are  official: 

Extractum   Colocynthidis,  U.   S.  P.     Dose,   2-5  gr.   (0.13-0.3 

gm.). 

Extractum  Colocynthidis  Compositum,  U.  S.  P.     Dose,  5-20  gr. 

(0.3-1.3  gm.). 

Pilulae  Catharticae  Compositae,  U.  S.  P.     Dose,  1-3  pills. 

Pilulae  Catharticae  Vegetabiles,  U.  S.  P.     Dose,  1-3  pills. 

Physiologic  Action  and  Therapeutics. — Colocynth  is  an  ener- 
getic drastic  cathartic,  producing  in  full  doses  copious,  watery  stools, 
accompanied  frequently  by  griping.  In  large  doses  the  irritation 
excites  inflammation  of  the  whole  alimentary  tract,  which  may  prove 
fatal.  The  drug  is  too  irritant  to  be  used  alone,  and  is  only  given  in 
combination  with  other  drugs  in  cases  of  obstinate  chronic  constipation, 
which  frequently  accompanies  old  age. 

CAMBOGIA— U.  S.  P. 

(Gamboge.) 

Gamboge  is  a  gum-resin  obtained  from  Garcinia  hanburii,  a 
laurel-like  tree  growing  in  the  East  Indies.  Its  active  principle  is 
cambogic  acid.  The  dose  of  the  drug  is  from  1/2-2  gr.  (0.03-0.13  gm.) . 
It  enters  into  the  following  official  preparation: 

Pilulae  Catharticae  Compositae,  U.  S.  P.     Dose,  1-3  pills. 

Physiologic  Action  and  Therapeutics. — Gamboge  is  an  active 
drastic  cathartic.  In  large  doses  its  irritant  effect  is  capable  of  causing 
fatal  gastroenteritis.  It  is  never  used  alone,  but  may  be  combined 
with  less  powerful  cathartics  and  used  in  obstinate  chronic  constipation. 

JALAPA— U.  S.  P. 

(Jalap.) 

Jalap  is  the  tuberous  root  of  Ipomaa  Jalapa,  a  perennial  herb 
growing  in  Mexico.  It  contains  two  glucosids,  jalapin  and  convol- 
vulin,  both  of  which  are  active.     The  dose  of  jalap  is  from  5-20  gr. 

(o-3-!-3  gm-)- 
14 


2IO  CATHARTICS. 

Its  official  preparations  follow: 

Extractum  Jalapae,  U.  S.  P.     Dose,  3-10  gr.  (0.2-0.6  gm.). 
Resina  Jalapae,  U.  S.  P.     Dose,  1-5  gr.  (0.06-0.3  gm.). 
Pulvis  Jalapae  Compositus,  U.  S.  P.  (contains  Jalap,  35;  Potas- 
sium Bitartrate,  65).     Dose,  15-60  gr.  (1.0-4.0  gm.). 
Pilulae  Cathartae  Compositas,  U.  S.  P.     Dose,  1-3  pills. 
Pilulae   Catharticae  Vegetables,   U.    S.   P.    (each  pill   contains 
extract  of  Jalap,    1/2   gr. — 0.03   gm.;   compound    extract  of 
Colocynth,  about   1    gr. — 0.06   gm.;   extract   of   Hyoscyamus, 
1/2  gr. — 0.03  gm.;  extract  of  Leptandra,  1/4  gr. — 0.015  gm.; 
extract  of  Podophyllum,  1  /4  gr. — o .  015  gm. ;  and  Oil  of  Pepper- 
mint).    Dose,  1-3  pills. 

Physiologic  Action  and  Therapeutics. — The  action  of  jalap  is 
more  like  that  of  the  hydragogue  cathartics  than  it  is  of  the  drastic.  It 
acts  gently,  producing,  within  three  or  four  hours,  copious,  watery 
stools.  Pharmacologists  (Stadelmann,  and  others)  claim  that  the  drug 
has  no  action  in  the  absence  of  bile,  the  latter  serving  in  all  probability 
as  a  solvent.  For  removing  the  water  from  the  tissues  in  dropsy  the 
drug  is  frequently  combined  with  a  saline,  as  in  the  official  compound 
powder  of  jalap.  It  is  not  employed  alone  as  a  cathartic,  but  it  is  an 
ingredient  of  both  the  official  compound  cathartic  pills  and  official 
compound  vegetable  pills,  which  preparations  are  frequently  given  in 
habitual  constipation. 


PODOPHYLLUM— U.  S.  P. 

(May  Apple;  Mandrake.) 

Podophyllum  is  the  rhizome  and  rootlets  of  Podophyllum  peltatum, 
a  perennial  herb,  growing  in  moist  woods  of  Canada  and  northern 
United  States.  It  contains  two  isomeric  glucosids,  podophyllotoxin  and 
picropodophyllin,  and  also  a  resin,  podophyllin,  which  is  official.  The 
dose  of  podophyllum  is  from  5-10  gr.  (0.3-0.6  gm.).  The  official 
preparations  are: 

Resina Podophylli,  U.  S. P.    Dose,  1/8-1/2  gr.  (0.008-0.03  gm.). 

Fluidextractum  Podophylli,  U.  S.  P.     Dose,  5-20  min.  (0.3-1.3 

c.c). 

Pilulae  Podophylli,  Belladonnae  et  Capsici,  U.  S.  P.  (each  pill 

contains  Podophyllin,  1/4  gr. — o.oi6gm.;  extract  of  Belladonna, 

1/8  gr. — 0.008  gm.;  pulv.  Capsicum,  1/2  gr. — 0.03  gm.;  with 

Acacia  and  Sugar  of  Milk).     Dose,  1-2  pills. 

The  resin  is  also  a  constituent  of  compound  cathartic  pills. 
Physiologic   Action   and   Therapeutics. — Podophyllum   is   an 


I'll   Kl    I  [CS.  211 

activr  drastic  cathartic.  Its  action  is  rather  slow,  however,  com- 
pared with  most  other  drastics;  it  generally  requiring  from  ten  to 
twelve  hours  for  it  to  produce  evacuation  of  the  bowel.  The  stools  are 
copious  and  watery,  and  usually  attended  with  more  or  less  griping  pain. 
The  drug  is  used  in  habitual  constipation,  associated  with  so-called 
biliousness.  "When  combined  with  other  cathartic  drugs,  those 
should  be  selected  which  are  also  slow  in  action,  like  aloes,  calomel,  etc. 
The  resin  is  the  most  reliable  preparation  and  is  generally  given  in  the 
form  of  pills. 

DIURETICS. 

Diuretics  are  agents  that  increase  the  flow  of  urine.  They  may 
act  indirectly  by  forcing  a  greater  volume  of  blood  through  the  kidneys, 
or  directly  by  stimulating  the  renal  epithelium.  A  number  of  them  act 
in  both  ways.  Certain  circulatory  stimulants  also  act  as  diuretics, 
among  which  may  be  mentioned  digitalis  and  caffein;  digitalis  ap- 
pears to  have  no  special  action  on  the  secreting  cells  of  the  kidneys,  its 
effect  as  a  diuretic  is  almost  entirely  dependent  upon  the  influence 
the  drug  has  over  the  cardiovascular  system.  Caffein,  on  the  other 
hand,  is  a  powerful  diuretic,  acting  directly  on  the  renal  epithelium, 
and,  in  a  lesser  degree,  on  the  circulation. 

The  inorganic  salts,  urea,  and  other  soluble  proteids,  normally 
present  in  the  blood,  may  be  regarded  as  the  physiologic  stimuli  of  the 
secreting  cells  of  the  kidneys.  Many  other  substances,  not  natural 
components  of  the  blood,  increase  the  secretion  of  urine  by  exerting  a 
direct  and  specific  influence  on  the  cells  of  the  glomeruli  and  convoluted 
tubes  (Stevens). 

Diuretics  are  employed  in  dental  practice  principally  for  the 
purpose  of  removing  from  the  blood  certain  excrementitious  matters, 
which  are  supposed  to  be  forerunners  of  pyorrhea  alveolaris.  The 
agents  used  are  chiefly  the  vegetable  salts  of  potassium  and  lithium, 
which  not  only  increase  the  amount  of  urine  excreted,  but,  being  elim- 
inated through  the  kidney  in  large  part  as  carbonates,  they  tend  to 
make  the  urine  alkaline  in  reaction.     Examples  follow: 

Potassium  Bicarbonate  Potassium  Chlorate. 

Potassium  Carbonate.  Potassium  Nitrate. 

Potassium  Citrate.  Lithium  Carbonate. 

Potassium  Acetate.  Lithium  Citrate. 

Potassium  Bitartrate.  Lithium  Benzoate 


212  DIURETICS. 

POTASSII  BICARBONAS— U.  S.  P. 

(Potassium  Bicarbonate;  KHC03.) 

Potassium  bicarbonate  occurs  in  colorless  prismatic  crystals, 
without  odor,  but  having  an  unpleasant,  saline,  alkaline  taste;  soluble 
in  3  parts  of  water,  and  practically  insoluble  in  alcohol.  The  dose  is 
from  10-30  gr.  (0.6-2.0  gm.).  Potassium  bicarbonate,  though  not 
contained  in  as  such,  is  used  in  making  the  following  official  solutions: 

Liquor  Potassii  Arsenitis,  U.  S.  P.  (Fowler's  Solution). 
Liquor  Potassii  Citratis,  U.  S.  P. 
Liquor  Magnesii  Citratis,  U.  S.  P. 

POTASSII  CARBONAS— U.  S.  P. 

(Potassium  Carbonate;  K2C03.). 

Potassium  carbonate  occurs  in  a  white,  granular,  deliquescent 
powder;  freely  soluble  in  water,  but  insoluble  in  alcohol.  The  dose 
is  from  10-30  gr.  (0.6-2.0  gm.).  The  drug  is  very  irritant  and  rarely 
used  as  such  internally;  from  potassium  carbonate,  however,  the 
following  official  preparations  are  made: 

Mistura  Ferri  Composita,  U.  S.  P. 

Pilulae  Ferri  Carbonatis,  U.  S.  P.  (Blaud's  Pills). 

POTASSII  CITRAS— U.  S.  P. 

(Potassium  Citrate;  K3C6H507.H20.) 

Potassium  citrate  occurs  in  transparent,  prismatic  crystals  or 
white,  granular,  deliquescent  powder,  without  odor,  but  having  a 
pleasant  saline  taste;  soluble  in  0.5  part  of  water,  but  sparingly 
soluble  in  alcohol.  The  dose  is  from  15-60  gr.  (1.0-4.0  gm.).  There 
are  two  official  preparations.     They  are: 

Liquor  Potassii  Citratis,  U.  S.  P.     Dose,  1/2-1  fl.  oz.  (15.0-30.0 

c.c). 

Potassii  Citras  Effervescens,    U.  S.  P.     Dose,  30-90  gr.   (2.0- 

6.0  gm.). 

POTASSII  BITARTRAS— U.  S.  P. 

(Potassium  Bitartrate;  Cream  of  Tartar;  KHC4H406.) 

Cream  of  tartar  occurs  in  colorless,  or  slightly  opaque,  rhombic 
crystals,  or  as  a  white  powder,  without  odor,  but  having  an  acidulous 
taste;  soluble  in  about  200  parts  of  water,  and  very  sparingly  soluble 


POTASSII  ACETAS.  213 

in  alcohol.     The  dose  is  from  15-60  gr.  (1.0  4.0  gm.).     It  is  a  compo- 
nent of  the  following  official  preparation: 

Pulvis  Jalapae  Compositus,  U.  S.  P.     Dose,  15-60  gr.  (1.0-4.0 
gm.). 

POTASSII  ACETAS -U.  S.  P. 

(Potassium  Acetate;  KC2H302.) 

Potassium  acetate  occurs  in  the  form  of  a  white  powder  or 
crystalline  masses,  very  deliquescent,  odorless,  and  having  a  pleasant 
saline  taste;  soluble  in  0.4  part  of  water  and  in  2  parts  of  alcohol. 
The  dose  is  from  15-60  gr.  (1.0-4.0  gm.). 

Physiologic  Action. — The  vegetable  salts  of  potassium  act 
similarly  and  will,  therefore,  be  discussed  here  conjointly.  The 
potassium  ion  is  much  more  physiologically  active  than  is  the  sodium 
ion,  and  as  a  result  the  potassium  salts,  as  a  rule,  are  more  irritant 
and  depressant  than  are  the  corresponding  sodium  salts.  With  the 
vegetable  salts  of  potassium,  however,  the  action  of  the  base  is  entirely 
subordinate  to  that  of  the  acid  radical,  and  a  depressant  effect  is  never 
observed  except  when  administered  continuously  or  in  enormous 
doses.  The  dominant  action  of  any  one  of  the  vegetable  salts  of  potas- 
sium is  upon  the  secreting  cells  of  the  kidneys,  increasing  the  amount 
of  urine.  The  mineral  salts  of  the  urine,  both  of  potassium  and 
sodium,  are  increased,  but  the  evidence  is  not  convincing  that  the 
vegetable  salts  of  potassium  materially  assist  oxidation  in  the  tissues, 
and  in  consequence  augment  nitrogenous  elimination.  In  large  doses 
they  do,  however,  impart  an  alkaline  reaction  to  the  urine,  and  in 
hyperisotonic  solution  they  act  as  saline  cathartics,  producing  free 
watery  discharges.  Potassium  bitartrate  differs  somewhat  from  the 
other  vegetable  salts  of  this  metal  in  that  it  resists  oxidation  in  the 
body,  and,  therefore,  much  of  it  is  eliminated  unchanged.  It  is  also  a 
more  active  cathartic. 

Therapeutics. — Clinical  experience  has  fully  demonstrated  that 
acute  rheumatism  is  intluenced  favorably  by  the  administration  of  the 
vegetable  salts  of  potassium;  and  it  is  also  true  that  pyorrhea  alveolaris 
in  rheumatic  or  gouty  subjects  is  favorably  influenced  by  these  salts, 
but  until  we  have  a  clearer  understanding  of  the  nature  of  these  diseases, 
it  is  useless  to  speculate  upon  the  mode  of  action  of  the  remedies 
employed  in  their  treatment.  In  these  cases  10-30  gr.  (0.6-2.0  gm.) 
of  the  salt  may  be  dissolved  in  water  and  administered.  The  dose 
should  be  repeated  every  three  or  four  hours  until  the  urine  becomes 


214  DIURETICS. 

neutral  or  slightly  alkaline.  Both  the  official  solution  of  potassium 
citrate  and  the  effervescent  salt  are  agreeable  preparations  to  take. 
Stevens1  speaks  favorably  of  combining  an  alkaline  salt  with  a  sali- 
cylic compound.  Salophen  may  be  selected  for  this  purpose,  for 
while  it  is  practically  insoluble  in  water,  it  is  freely  soluble  in  watery 
solutions  of  the  alkaline  salts. 

The  vegetable  salts  of  potassium  are  efficient  sedative  expecto- 
rants in  the  beginning  of  acute  bronchitis,  especially  when  the  secretion 
is  viscid  and  scanty. 

Incompatibles. — The  vegetable  salts  of  potassium  are  incom- 
patible with  acids,  mineral  salts,  and  alkaloidal  salts. 

POTASSII  CHLORAS— U.  S.  P. 

Potassium  Chlorate;  KC103.) 

Potassium  chlorate  occurs  in  colorless,  crystalline  plates,  with- 
out odor,  but  having  a  cooling  saline  taste;  soluble  in  16  parts  of 
water,  sparing  soluble  in  alcohol.  The  dose  is  from  5-20  gr.  (0.3-1.3 
gm.)     There  is  one  official  preparation: 

Trochisci  Potassii  Chloratis,  U.  S.  P.  (each  contains  about  21/2 
gr.-0.15  g111-)     Dose,  1-5  troches. 

Physiologic  Action. — Potassium  chlorate,  when  applied  in  dilute 
form  to  the  mucous  membrane,  acts  as  a  stimulating  alterative;  in  con- 
centrated form  it  is  a  decided  irritant.  The  exact  manner  of  its  action 
is  not  fully  understood.  It  was  supposed  formerly  that  the  drug,  when 
internally  administered,  yielded  its  oxygen  to  the  blood,  but  recent  in- 
vestigation tends  to  prove  that  fully  90  per  cent,  passes  out  of  the  body 
unchanged  in  the  urine,  though  small  quantities  have  been  detected  in 
the  saliva,  tears,  and  milk  of  nursing  women.  In  moderate  doses,  well 
diluted,  its  only  noticeable  effect  is  to  increase  the  flow  of  urine. 

Poisoning  and  Treatment. — In  excessively  large  doses  potassium 
chlorate  produces  toxic  symptoms.  Its  basic  radical  depresses  the 
circulation  and  nervous  system,  while  its  acid  radical  irritates  the 
stomach,  intestines,  and  kidneys.  In  the  treatment  of  poisoning  the 
stomach  should  be  evacuated  by  emetics  or  the  stomach-pump,  fol- 
lowed, as  usual,  with  demulcents.  In  case  of  exhaustion,  normal  salt 
solution  may  be  subcutaneously  injected. 

Therapeutics. — In  all  inflammatory  conditions  of  the  mouth  and 
throat,  potassium  chlorate  makes  an  excellent  local  application.  Ten 
grains  (0.6  gm.)  to  the  ounce  (30.0  c.c.)  may  be  used  as  a  wash,  gargle, 

1  Modern  Materia  Medica  and  Therapeutics. 


POTASSII    NITRAS— LITFIII    CARBONAS.  215 

or  spray.  In  mercurial  stomatitis,  the  salt  is  almost  a  specific,  and 
may  be  employed  internally  as  well  as  locally.  It  is  quite  generally 
believed  by  medical  men  that  salivation  is  less  likely  to  follow  the  con- 
tinuous use  of  mercury  in  secondary  syphilis  when  a  solution  of  potas- 
sium chlorate  is  simultaneously  used  as  a  mouth-wash.  Oral  pro- 
phylaxis and  mouth  hygiene  are  considered  important  factors  in  the 
treatment  of  syphilis  to-day. 

Incompatibles. — Potassium  chlorate,  being  rich  in  oxygen  which 
it  readily  gives  up,  makes  the  drug  incompatible  with  many  easily 
oxidizable  substances,  like  sulphur,  phosphorus,  pulverized  charcoal, 
tannic  acid,  sugar,  sulphids,  hyposulphites,  hyposphosphites,  and  am- 
monium chlorid. 


POTASSII  NITRAS— U.  S.  P. 
(Potassium  Nitrate;  Saltpeter;  KN03.) 

Potassium  nitrate  occurs  in  colorless,  transparent,  rhombic 
prisms  or  as  a  crystalline  powder,  odorless,  and  having  a  cooling  saline 
taste;  soluble  in  3.6  parts  of  water,  sparingly  soluble  in  alcohol.  The 
dose  is  from  10-30  gr.  (0.6-2.0  gm.)  in  solution,  well  diluted. 

Physiologic  Action  and  Therapeutics. — Except  that  it  is  more 
irritating  to  the  stomach,  the  action  of  potassium  nitrate  in  moderate 
doses,  does  not  differ  materially  from  the  vegetable  salts  of  potassium; 
it  increases  the  secretion  of  urine  through  direct  action  on  the  renal 
epithelium.  In  large  doses  potassium  nitrate  is  not  only  more  irritating 
than  the  vegetable  salts,  but  is  markedly  more  depressant  to  the  heart 
and  nervous  system;  for  here  the  action  of  the  base  (potassium)  is  not 
subordinate  to  that  of  the  acid  radical.  Toxic  doses  produce  the 
symptoms  of  gastroenteritis,  muscular  weakness,  and  collapse. 

Potassium  nitrate  is  not  used  in  dental  therapeutics.  It  has  been 
employed  in  general  dropsy,  but  it  has  no  greater  efficacy  than  the  less 
irritating  vegetable  salts.  Inhalations  of  the  smoke  of  burning  niter 
paper,  formerly  official,  sometimes  affords  relief  in  asthma.  Solutions 
of  the  drug,  called  "brine,"  are  useful  for  preserving  meats. 

LITHII  CARBONAS— U.  S.  P. 

(Lithium  Carbonate;  Li2Co3.) 

Lithium  carbonate  occurs  as  a  white  powder,  without  odor, 
but  having  an  alkaline  taste;  soluble  in  75  parts  of  water  and  insoluble 
in  alcohol.     The  dose  is  from  5-20  gr.   (0.3-1.3  gm.). 


2l6  DIURETICS. 

LITHII  CITRAS— U.  S.  P. 

(Lithium  Citrate;   Li3C6HsOr4H20.) 

Lithium  citrate  occurs  as  a  white,  deliquescent  powder,  without 
odor,  but  having  a  cooling  saline  taste;  soluble  in  2  parts  of  water, 
insoluble  in  alcohol.     The  dose  is  from  5-30  gr.  (0.3-2.0  gm.). 

LITHII  BENZOAS— U.  S.   P. 

(Lithium     Benzoate;     LiC7Hs02.) 

Lithium  benzoate  occurs  in  the  form  of  white,  shining  scales  or 
powder,  odorless  and  of  a  cooling,  sweetish  taste.  The  dose  is  from 
5-30  gr.  (0.3-2.0  gm.). 

Physiologic  Action  and  Therapeutics.— The  action  of  the 
vegetable  salts  of  lithium  is  very  similar  to  that  of  the  corresponding 
salts  of  potassium,  because  the  action  of  the  base  in  both  groups  is 
entirely  subordinate  to  that  of  the  acid  radical.  They  increase  the 
quantity  of  urine  and  lessen  its  acidity. 

The  salts  of  lithium  have  been  recommended  in  the  treatment  of 
gout  and  the  uric  acid  diathesis  because  it  was  found  that  outside  of  the 
body  lithium  united  with  uric  acid  to  form  a  more  soluble  salt  than  did 
either  potassium  or  sodium,  but  since  it  has  been  clearly  demonstrated 
that  alkaline  medication  is  without  influence  on  the  uratic  salts  present 
in  the  blood  or  tissues,  it  is  doubtful  whether  the  salt  of  lithium  are 
any  more  potent  in  these  diseases  than  are  the  vegetable  salts  of 
potassium  (Stevens) .  On  the  hypothesis  that  the  concretions  in  pyor- 
rhea alveolaris  were  precipitated  and  deposited  on  the  roots  of  teeth  as 
the  blood,  supercharged  with  suboxidized  or  excrementitious  material, 
slowly  passed  through  the  pericemental  membrane,  lithium  salts  and 
the  natural  mineral  waters  have  been  extensively  employed  in  the 
treatment  of  this  condition.  But,  as  above  mentioned,  since  it  is 
clearly  proven  that  lithium  salts  are  without  influence  on  the  urates 
in  the  blood  or  tissues,  and  since,  too,  that  it  has  never  been  clearly 
demonstrated  that  the  deposits  are  formed  from  the  source  mentioned, 
it  is  indeed  doubtful  whether  these  salts  play  any  role  in  the  eradication 
of  the  disease,  except  to  increase  the  amount  of  urine.  In  the  case  of 
the  natural  waters,  the  efficacy  which  they  may  possess  in  this  disease 
is  probably  dependent  upon  the  depurant  (purifying)  action  of  the 
water  itself  and  not  upon  the  small  amount  of  salt  they  contain.  On 
this  basis,  the  drinking  of  large  quantities  of  pure,  wholesome  water 
in  the  treatment  of  this  disease  is  recommended. 


DIAPHORETICS.  217 

DIAPHORETICS. 

Diaphoretics  arc  agents  which  promote  the  secretion  of  per 
spiration.  When  the  action  of  the  remedy  is  such  that  the  sweat 
stands  in  beads  upon  the  surface,  it  is  called  a  sudorific. 

The  agents  employed  may  act  directly  by  stimulating  the  special 
nerve  fibers  supplying  the  sweat  glands,  indirectly  by  stimulating  the 
sweat  centers  of  the  central  nervous  system  from  which  those  fibers 
originate,  or  retlexly  by  irritating  peripheral  sensory  nerves.  The 
activity  of  the  sweat  glands  is  increased  by  dilatation  of  the  peripheral 
vessels,  external  heat,  muscular  exercise,  dyspnea,  strong  emotion, 
nausea,  and  various  drugs  (Stevens).  Diaphoretics  are  chiefly  used 
for  their  evacuant,  revulsive,  and  alterative  effects,  and  also  to  promote 
absorption.  The  drugs  usually  employed  for  promoting  perspiration 
are: 

Pilocarpus.  Liquor  Ammonium  Acetate. 

Spirit  of  Nitrous  Ether.  Opium.* 

PILOCARPUS— U.  S.  P. 

(Jaborandi.) 

Pilocarpus  is  the  leaflets  of  Pilocarpus  jaborandi  and  Pilocarpus 
micro phyllus,  schrubs  growing  in  South  America.  It  contains  three 
alkaloids — pilocarpin,  pilocarpidin,  and  isopilocarpin — all  of  which 
are  physiologically  active,  but  pilocarpin  is  the  most  active,  is  present 
in  greater  quantity,  and  yields  with  acids  soluble  crystalline  salts,  of 
which  two  are  official:  Pilocarpine  Nitras,  U.  S.  P.,  and  Pilocarpines 
Hydrochloridum,  U.  S.  P.  These  salts  are  most  commonly  used;  the 
dose  of  either  is  from  1/12-1/2  gr  (0.005-0.03  gm.).  The  dose  of 
pilocarpus  is  from  5-60-  gr.  (0.3-4.0  gm.).  There  is  one  official 
preparation  of  the  drug. 

Fluidextractum  Pilocarpi,  U.   S.   P.     Dose,    10-60  min.   (0.6- 
4.0  c.c). 

Physiologic  Action  and  Therapeutics. — Probably  no  other 
single  drug  exerts  the  same  influence  on  the  secretory  glands  of  the 
body  as  pilocarpin.  When  internally  administered,  even  in  small 
doses,  the  sweat  and  saliva  are  markedly  increased.  It  also  increases, 
but  to  a  lesser  degree,  the  lacrimal,  nasal,  bronchial,  gastric,  intestinal, 
and  renal  secretions.  The  fact  that  atropin  completely  suspends  the 
effect  of  pilocarpin  on  the  secretions  has  led  pharmacologists  to  believe 
that  the  drug  acts  by  stimulating  the  peripheral  fibers  of  the  nerves 
supplying  the  various  glands. 


2l8  EMETICS. 

Pilocarpin  is  not  much  used  in  dental  therapeutics.  In  acute 
uremia  large  doses  1/6-1/3  gr.  (0.01-0.02  gm.)  may  be  used  in  con- 
junction with  external  heat  (hot  air  or  hot  vapor  baths).  The  drug 
is  sometimes  used  for  its  diaphoretic  effect  in  acute  rheumatism  and 
acute  coryza. 

SPIRITUS  iETHERIS  NITROSI— U.  S.  P. 

(Spirit  of  Nitrous  Ether;  Sweet  Spirit  of  Niter.) 

Spirit  of  nitrous  ether,  commonly  called  sweet  spirit  of  niter, 
is  an  alcoholic  solution  of  ethyl  nitrite,  containing  not  less  than  4 
per  cent,  of  pure  ethyl  nitrite.  It  occurs  as  a  clear,  volatile,  inflam- 
mable liquid,  having  a  yellowish  or  greenish  tint,  a  pleasant  ethereal 
odor,  and  a  sharp,  burning  taste.  It  should  be  kept  in  well-stoppered 
bottles  away  from  light.  The  dose  is  from  10-120  minims  (0.6- 
8.0  c.c),  depending  upon  the  age  of  the  patient. 

Physiologic  Action  and  Therapeutics. — Spirit  of  nitrous  ether 
acts  as  a  mild  diaphoretic,  diuretic,  and  antispasmodic.  Its  diapho- 
retic effect  is  more  pronounced  than  its  diuretic  effect  when  the  patient 
is  kept  well  under  cover  after  its  administration;  the  action  is  reversed 
when  the  patient  is  lightly  covered.  It  appears,  therefore,  that  exter-. 
nal  heat  augments  its  diaphoretic  action. 

Sweet  spirit  of  niter  is  used  extensively  as  an  antispasmodic 
remedy  in  convulsions  which  frequently  occur  in  children  during  the 
eruptive  period  of  the  diciduous  teeth.  It  is  best  given  in  small  doses, 
at  frequent  intervals,  well  diluted  with  water. 

LIQUOR  AMMONII  ACETATIS— U.  S.  P. 

(Solution  of  Ammonium  Acetate;  Spirit  of  Mindererus.) 

This  is  a  solution  of  diluted  acetic  acid  nearly  saturated  with 
ammonium  carbonate.  It  should  be  slightly  acid  in  reaction,  contain 
about  7  per  cent,  of  ammonium  acetate,  and  prepared  as  wanted. 
Somewhat  like  sweet  spirit  of  niter,  it  acts  as  a  feeble  diaphoretic  or 
diuretic  according  as  the  patient  is  kept  warm  or  cool.  It  is  largely 
used  in  mild  febrile  affections  of  children  as  a  vehicle  for  spirit  of  nitrous 
ether  or  preparations  of  aconite.  The  dose  is  from  1-4  fl.  dr.  (4.0- 
15.0  c.c). 

EMETICS. 

Emetics  are  agents  which  produce  vomiting  (emesis).  It  is  sup- 
posed that  drugs  act  to  produce  emesis  either  by  directly  affecting 


APOMORIMIIVK    IIVDKOCHI.ORIDUM.  210. 

the  center  in  the  medulla  or  by  indirectly  affecting  it  through  irritation 
of  the  sensory  nerve  endings  in  the  stomach.  There  is  little  doubt 
but  what  the  action  of  apomorphin  is  a  direct  one;  ipecac  and  anti- 
mony undoubtedly  act  both  directly  and  indirectly;  and  all  evidence 
goes  to  show  that  zinc  sulphate,  copper  sulphate,  alum,  mustard,  and 
tepid  water  act>  in  the  main  at  least,  indirectly. 

Emetics  may  be  used  for  one  of  four  purposes: 

1.  To  expel  poisons  or  undigested  food,  which  is  causing  pain, 
headaches,  etc.,  from  the  stomach.  For  this  purpose  the  indirect  or 
local  emetics  are  the  most  reliable,  especially  in  cases  of  poisoning. 

2.  To  expel  foreign  bodies,  false  membranes,  or  excessive  secre- 
tion from  the  respiratory  tract;  the  effort  of  vomiting  often  being  suffi- 
cient to  dislodge  and  remove  the  membrane  or  foreign  body.  For 
this  purpose  the  direct  or  systemic  emetics  should  be  used. 

3.  To  expel  foreign  bodies  from  the  esophagus.  Direct  or 
systemic  emetics  are  indicated  again  here. 

4.  To  expel  mucus  and  bile  from  the  gall  ducts  in  catarrhal 
jaundice.  For  this  purpose  the  direct  or  systemic  emetics  are  perhaps 
the  most  useful. 

Emetics  are  principally  used  in  dental  therapeutics  for  the  im- 
mediate expulsion  of  poisons  that  may  have  been  swallowed  accident- 
ally or  otherwise.  It  should  be  remembered  that  for  this  purpose  the 
local  emetics  are  employed. 

The  chief  emetics  are: 

Apomorphin.  Copper  Sulphate.* 

Ipecac.  Alum.* 

Tartar  Emetic.  Mustard.* 

Zinc  Sulphate.*  Tepid  Water,  in  quantity. 

APOMORPHINiE  HYDROCHLORIDUM— U.   S.  P. 

(Apomorphin  Hydrochlorid.) 

Apomorphin  is  an  artificial  alkaloid  obtained  from  morphin  by 
abstracting  a  molecule  of  water.  It  is  official  as  the  hydrochlorid, 
which  occurs  in  minute,  grayish-white,  acicular  crystals,  odorless,  and 
having  a  slightly  bitter  taste;  soluble  in  about  50  parts  of  water  or 
alcohol.  The  dose  as  an  emetic  is  from  1  / 12-1  /6  gr.  (0.005-0.01  gm.) ; 
as  an  expectorant,  from  1/30-1/ 20  gr.  (0.002-0.003  gm.). 

Physiologic  Action  and  Therapeutics. — From  five  to  twenty 
minutes  after  ingestion,  according  to  the  dose  and  method  of  admin- 
istration of  apomorphin,  vomiting  ensues,  being  repeated  three  or  four 


220  EMETICS. 

times  at  intervals  of  about  fifteen  minutes.  The  emesis  is  preceded 
and  attended  by  slight  nausea,  but  with  moderate  depression.  The 
entire  action  of  apomorphin  is  upon  the  medulla;  it  is,  therefore,  a 
direct  or  systemic  emetic,  being  the  most  powerful  and  certain  we 
possess;  and  is  used  whenever  such  an  emetic  is  indicated. 

IPECACUANHA— U.  S.  P. 

(Ipecac.) 

Ipecac  is  the  root  of  Cephaelis  ipecacuanha,  or  Cephaelis  acumi- 
nata, a  perennial  shrub  growing  in  Brazil  and  other  South  American 
states.  It  contains  two  alkaloids,  emetin  and  cephaelin,  and,  accord- 
ing to  some  authorities,  also  psychrotin.  The  dose  of  the  powdered 
drug  as  an  emetic  is  from  15-30  gr.  (1.0-2.0  gm.);  as  an  expectorant, 
1/2-2  gr.  (0.03-0.13  gm.). 

The  following  are  its  official  preparations: 

Fluidextractum  Ipecacuanhae,   U.   S.  P.     Dose,  as  an  emetic, 

15-30  min.  (1 . 0-2 .  o  c.c.) ;  as  an  expectorant,  2-5  min.  (o .  1-0 . 3 

c.c). 

Syrupus   Ipecacuanhas,    U.    S.   P.     Dose,    as   an   emetic,    2-4 

fl.  dr.  (8.0-15.0  c.c);  as  an  expectorant,  10-60  min.  (0.6-4.0 

c.c). 

Vinum  Ipecacuanhae,  U.  S.  P.     Dose,  as  an  emetic,  2-4  fl.  dr. 

(8.0-15.0  c.c);  an  expectorant,  10-60  min.  (0.6-4.0  c.c). 

Tinctura  Ipecacuanhae  et  Opii,  U.  S.  P.  (contains  1  gr. — 0.06  gm. 

each  of  Powdered  Ipecac  and  Powdered  Opium  in  10  min. — 0.6 

c.c).     Dose,  5-15  min.  (0.3-1.0  c.c). 

Pulvis  Ipecacuanhas  et  Opii,  U.  S.  P.  (Dover's  Powder:  Ipecac, 

1  part;  Opium,  1  part;  Sugar  of  Milk,  8  parts).     Dose,  5-10  gr. 

(0.3-0.6  gm.). 

Pilulae  Laxativas  Compositae,  U.  S.  P.  (each  pill  contains  Ipecac, 

1/16  gr. — 0.004  gm->  Aloin,   1/5  gr. — 0.013  gm->  Strychnin, 

i/i2ogr. — 0.0005  gm-;  extract  of  Belladonna,  1/8  gr. — 0.008 

gm.;  with  Licorice  and  Syrup).     Dose,  1-3  pills. 

Physiologic  Action  and  Therapeutics. — Ipecac  is  a  powerful  ir- 
ritant to  the  mucous  membranes  of  the  respiratory  tract  when  the 
powdered  drug  is  inhaled.  Its  prolonged  application  to  the  skin  pro- 
duces much  irritation,  and  even  vesication,  pustulation,  and  ulceration 
often  result.  The  drug  is  claimed  to  possess  some  antiseptic  proper- 
ties. Internally  administered  in  small  doses,  ipecac  acts  as  a  stimu- 
lant to  the  salivary  and  gastric  glands,  its  action  here  is  not  unlike  that 
of  the  vegetable  bitters.  In  large  doses  the  drug  is  a  powerful  irritant 
and  emetic,  the  emesis  in  all  probability  being  due  to  both  a  local  ir- 


EXPECTORANTS.  221 

ritation  of  the  peripheral  sensory  nerve  endings  in  the  stomach  and 

some  slight  action  on  the  medulla  itself. 

The  drug  also  exerts  a  favorable  influence  on  the  bronchial 
mucous  membrane,  acting  as  a  sedative  expectorant,  and  is  frequently 
employed  as  a  component  of  cough  mixtures.  Ipecac,  though  not 
very  prompt  inits  action,  is  a  safe  and  reliable  emetic.  It  is  especially 
useful  in  children,  in  whom  it  is  extensively  used  to  expel  irritant 
material  from  the  stomach. 

The  drug  has  been  empirically  used  for  a  variety  of  purposes 
other  than  that  of  an  emetic  and  expectorant.  It  is  used  as  an  anti- 
emetic, antidysenteric,  diaphoretic,  etc. 

ANTIMONII  ET  POTASSII  TARTRAS— U.  S.  P. 

(Antimony  and  Potassium  Tartrate;  Tartar  Emetic; 

2K(SbO)C4H406.H20.) 

Tartar  emetic  occurs  in  the  form  of  colorless,  transparent  crystals 
or  as  a  white  granular  powder,  odorless,  and  having  a  sweetish,  me- 
tallic taste;  soluble  in  15.5  parts  of  water,  and  practically  insoluble  in 
alcohol.  The  dose  as  an  emetic  is  from  1/2-1  gr.  (0.03-0.06  gm.); 
as  an  expectorant,  1/16-1/ 12  gr.  (0.004-0.005  gm.).  The  official 
preparations  are: 

Vinum  Antimonii,  U.  S.  P.  (contains  2  gr. — o.  13  Tartar  Emetic 
to  1  fl.  oz. — 30  c.c).  Dose,  as  an  emetic,  1/2-1  fl.  oz.  (15.0- 
30.0  c.c);  as  an  expectorant,  10-30  min.  (0.6-2.0  c.c). 
Syrupus  Scillae  Compositus,  U.  S.  P.  (contains  Tartar  Emetic,  2; 
Squill,  Senega,  Sugar,  and  Water  to  make  1000).  Dose,  5-60 
min.  (0.3-4.0  c.c). 

Physiologic  Action  and  Therapeutics. — Tartar  emetic  is  an 
irritant  and  acts  as  an  emetic  and  expectorant.  The  drug  is  fast 
falling  into  disuse  in  medical  practice,  having  been  displaced  largely 
by  other  drugs  which  are  more  prompt  in  their  action  and  less  depress- 
ant. There  is  little  need  of  the  drug  in  dental  therapeutics,  it  having 
been  considered  here  because  of  its  past  record  as  an  emetic,  sedative 
expectorant,  diaphoretic,  and  counterirritant. 

Tepid  water  in  large  quantities  generally  acts  as  an  emetic. 

EXPECTORANTS. 

Expectorants  are  drugs  which  modify  the  secretion  of  mucus 
from  the  mucous  membrane  of  the  air-passages,  affect  its  quantity, 
and  facilitate  its  expulsion.     The  exact  mode  of  their  action  is  not  well 


2  22  EXPECTORANTS. 

understood.  Those  that  promote  secretion  and  render  it  less  viscid 
in  character,  and,  therefore,  more  easily  removed,  are  generally  called 
sedative  expectorants.     Examples  of  this  class  are: 

Ipecac*  Tartar  Emetic* 

Apomorphin.*  Potassium  Citrate.* 

Those  drugs  which  stimulate  the  mucous  membrane  of  the  re- 
spiratory tract  and  lessen  the  quantity  of  sputum  are  termed  stimulant 
expectorants.     The  most  important  are: 

Ammonium  Chlorid.  Squill. 

Eucalyptus  (Eucalyptol).*  Benzoic  Acid.* 

Oil  of  Myrtle. 

AMMONII  CHLORIDUM— U.  S.  P. 

(Ammonium  Chlorid;  Sal  Ammoniac;  NH4C1.) 

Ammonium  chlorid  occurs  as  a  white  crystalline  powder,  odor- 
less, and  having  a  cooling,  saline  taste;  soluble  in  2  parts  of  water  and 
in  50  parts  of  alcohol.  The  drug  has  the  peculiar  physical  property 
of  passing,  when  heated,  directly  from  the  solid  to  the  gaseous  state, 
and  on  cooling,  from  the  gaseous  directly  to  the  solid  state.  In  other 
words,  it  differs  from  most  salts  in  that  it  cannot  be  liquefied  by  heat. 
The  dose  is  from  5-20  gr.  (0.3-1.3  gm.).  The  following  preparation 
is  official: 

Trochisci  Ammonii  Chloridi,  U.  S.  P.  (each  contains  Ammonium 
Chlorid,  1  1/2  gr. — 0.19  gm.;  Extract  of  Licorice,  3  gr. — 0.2 
gm.;  with  Tragacanth,  Sugar,  and  Syrup  of  Tolu).  Dose,  1-2 
troches. 

Physiologic  Action  and  Therapeutics. — Administered  in 
moderate  doses  by  the  mouth,  ammonium  chlorid  acts  chiefly  as  a 
stimulant  to  the  mucous  membrane  of  the  respiratory  tract  and  per- 
haps, also,  of  the  stomach  and  bowel.  It  increases  the  quantity  and 
renders  less  viscid  the  mucous  secretion.  The  drug  for  the  most  part 
is  eliminated  in  the  urine  unchanged. 

Ammonium  chlorid  is  extensively  employed  as  a  stimulant  expec- 
torant in  acute  bronchial  catarrh,  subacute  and  chronic  pharyngitis,  etc. 

Incompatibles. — The  drug  is  incompatible  with  alkalies,  mineral 
acids,  tartaric  acid,  and  the  soluble  salts  of  silver  and  lead. 

SCILLA— U.  S.  P. 

(Squill.) 

Squill  is  the  bulb  of  Urginea  maritima,  a  perennial  herb,  growing 
on  the  shores  of  the  Mediterranean  Sea.     It  is  supposed  to  contain 


SIALOGOGUES.  223 

several  active  principles,  no  one  of  which,  when  isolated,  fully  represents 
the  activity  of  the  crude  drug.  The  dose  is  from  1-3  gr.  (0.06-0.2  gm.) . 
The  official  preparations  are: 

Acetum  Scillae,  U.  S.  P.     Dose,  10-30  min.  (0.6-2.0  c.c). 
Tinctura  Scillae,  U.  S.  P.     Dose,  5-20  min.  (0.3-1.3  c.c). 
Fluidexfractum  Scillae,  U.  S.  P.     Dose,  1-3  min.  (0.06-0.2  c.c). 
Syrupus  Scillae,  U.  S.  P.     Dose,  1/2-1  fl.  dr.  (2.0-4.0  c.c). 
Syrupus  Scillae  Compositus,   U.    S.  P.  (contains    fluid  extract 
of  Squill,  8  per  cent.;   fluid   extract   of  Senega,  8   per  cent.; 
Tartar  Emetic,  2  per  cent.).     Dose,  10-60  min.  (0.6-4.0  c.c). 

Physiologic  Action  and  Therapeutics. — The  action  of  squill 
somewhat  resembles  that  of  digitalis,  though  it  is  much  less  powerful. 
It  also  acts  as  a  stimulant  expectorant  and  a  diuretic.  The  syrup  of 
squill  is  a  common  component  of  cough  mixtures. 

OLEUM  MYRTI— Unofficial. 
(Oil  of   Myrtle;   Myrtol.) 

Oil  of  myrtle  is  a  greenish-yellow,  volatile  oil,  distilled  from  the 
leaves  and  flowers  of  Myrtus  communis,  the  common  European  myrtle. 
Its  properties  are  almost  identical  with  those  of  eucalyptol.  The  dose 
is  from  3-10  min.  (0.2-0.6  c.c).  It  may  be  employed  as  a  stimulant 
expectorant  in  cases  of  cold  in  the  head.  A  few  minims  may  be  added 
to  a  basin  of  hot  water  and  the  fumes  inhaled.  It  may  also  be  taken 
internally  by  placing  2-3  min.  (0.13-0.2  c.c.)  of  the  oil  on  a  blank 
sugar  tablet  or  a  piece  of  loaf-sugar.  Harlan  recommends  the  drug 
for  the  treatment  of  putrescent  pulps,  but  it  is  of  doubtful  value,  other 
remedies  for  this  purpose  having  completely  displaced  the  essential  oils. 

SIALOGOGUES. 

Sialogogues  are  drugs  or  remedies  which  stimulate  the  salivary 
and  buccal  mucous  glands,  increasing  the  secretion  and  flow  of  saliva 
and  buccal  mucus.  There  are  many  diseases  and  conditions  which 
change  the  character  and  flow  of  the  mouth  secretions.  Among  the 
men  who  have  experimented  with  mouth  secretions  in  relation  to  health 
and  disease  may  be  mentioned  Black,  Miller,  Williams,  Michaels, 
Kirk.  Acre,  Hinkins,  Cook,  and  others.  Michaels  claims  the  saliva 
to  be  pathognomonic  of  certain  diseases,  the  diagnosis  being  made 
by  physical  and  chemic  examinations  of  the  saliva.  Cook  has  shown 
that  astringent  mouth-washes  interfere  for  hours  with  the  action  of 


2  24  CARMINATIVES. 

ptyalin  upon  starchy  food.  The  mixed  saliva  is  normally  alkaline  in 
reaction.  The  author,  collaborating  with  Hinkins  and  Cook,  spent 
considerable  time  investigating  the  cause  of  erosion.  One  point 
established  beyond  doubt,  which  has  also  been  mentioned  by  other 
investigators,  was  that  the  saliva  in  typical  cases  of  erosion  is  always 
acid.  Hinkins  has  repeatedly  called  attention  to  the  fact  that  simply 
holding  the  mouth  open  for  any  length  of  time,  as  in  dental  operations 
where  the  rubber  dam  is  used,  materially  affects  the  character  and  flow 
of  saliva.  Chewing  a  piece  of  clean  wood,  rubber,  and  even  gum  or 
tobacco  augments  the  flow  of  saliva,  as  does  also  the  smell  of  victuals. 
Many  drugs  also  produce  a  sialogogue  effect,  the  most  important  of 
which  have  been  discussed  under  other  headings.     They  are: 

Pilocarpus  (Jaborandi).*  Potassium  Chlorate.* 

Mercurials.*  Echafolta.* 

Iodin  Compounds.*  Tobacco.* 
Acetic  Acid.* 

To  collect  saliva  for  experimental  purposes  almost  any  clean 
substance  may  be  chewed,  the  mere  movements  of  the  jaws  stimulate 
the  gland.  Another  means  is  to  place  the  tongue  on  the  roof  of 
the  mouth  and  inhale  dilute  acetic  acid  through  the  mouth.  This 
stimulates  the  secretion  especially  from  the  sublingual  gland. 

The  role  played  by  the  saliva  in  mouth  diseases  is  by  no  means 
settled,  and  this  field  offers  an  excellent  opportunity  for  further  investi- 
gation to  those  scientifically  inclined. 

CARMINATIVES. 

Carminatives  are  drugs  that  aid  in  the  expulsion  of  gas  from  the 
stomach  or  intestines.  The  gas  found  in  the  alimentary  canal  comes 
from  various  sources:  it  may  have  been  swallowed  with  the  food,  formed 
by  the  action  of  acid  upon  the  carbonates  contained  in  the  food  and  sali- 
iva,  or  it  may  be  generated  through  fermentation  or  putrefaction  of 
the  stomach  contents;  fermentation  being  the  most  common  cause  of 
abnormal  accumu'ation  of  gas.  Although  this  class  of  drugs  are 
chiefly  valuable  in  the  expulsion  of  gas  already  formed,  they  also  pre- 
vent, to  a  more  or  less  degree,  the  formation  of  flatus,  for,  by  quicken- 
ing the  gastric  circulation,  they  doubtless  stimulate  glandular  activity, 
thus  they  act  as  stomachics  by  aiding  digestion  and  lessening  fer- 
mentation. Carminatives  are  frequently  combined  with  purgative 
drugs;  here  they  act  as  correctives  by  modifying  or  correcting  the  griping 
pain  which  purgatives  are  likely  to  induce  when  given  alone. 


PIPES      MYBJSTICA     -ZINGIBER.  225 

Most  of  the  drugs  belonging  to  this  class  are  aromatics  containing 
essential  oils  as  their  chief  active  constituent.  Alcohol,  ether,  and 
chloroform  are  the  exceptions.     The  principal  carminatives  are: 


Capsicum.* 

Cardamom. 

Caraway. 

Pepper. 

Cloves.* 

Fennel. 

Nutmeg. 

Cinnamon.* 

Coriander. 

Ginger. 

Anise. 

Mustard.* 

Peppermint.* 

Allspice. 

Alcohol.* 

Spearmint. 

Sassafras. 
Chloroform.* 

PIPER— U.  S.  P. 

(Black  Pepper.) 

Ether.* 

Black  pepper  is  the  unripe  fruit  of  Piper  nigrum,  a  climbing  vine 
cultivated  in  the  East  Indies.  It  contains  a  crystalline  neutral  principle, 
pipcrin,  a  volatile  oil,  and  a  pungent  resin.  The  dose  of  ground  pepper 
is  from  5-20  gr.  (0.3-1.3  gm.). 

The  preparations  follow: 

Piperia,  U.  S.  P.     Dose,  1-5  gr.  (0.06-0.3  Sm-)- 

Oleoresina  Piperis,  U.  S.  P.     Dose,  1/2-2  min.  (0.03-0.1  c.c). 

Pepper  is  a  carminative  and  is  largely  used  as  a  condiment. 

MYRISTICA— U.  S.  P. 
(Nutmeg.) 

Nutmeg  is  the  seed  of  Myrislica  fra grans,  an  evergreen  tree 
growing  in  the  Molucca  Islands  and  other  East  India  islands.  It  con- 
tains a  volatile  oil,  to  which  its  aromatic  properties  are  due,  also  a  fixed 
oil.  The  dose  is  from  5-20  gr.  (0.3-1.3  gm.).  The  volatile  oil  is 
official. 

Oleum  Myristicze,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3  c.c). 

Xutmeg  is  used  as  a  condiment.  It  also  enters  as  an  aromatic 
into  many  of  the  official  aromatic  and  compound  preparations. 

Mace  is  the  ground  fleshy  covering  (arillode)  of  nutmeg.  It  is 
used  as  a  condiment. 

ZINGIBER— U.  S.  P. 

(Ginger.) 

Ginger  is  the  ground  rhizome  of  Zingiber  officinale,  a  perennial 
herb  growing  in  the  tropical  countries.     It  contains  a  volatile  oil, 


226  CARMINATIVES. 

having  the  odor  of  ginger,  and  a  viscid  resinous  principle,  having  a  hot, 
pungent  taste.     The  dose  is  from  5-20  gr.  (0.3-1.3  gm.). 

The  following  preparations  are  official: 

Tinctura  Zingiberis,  U.  S.  P.     Dose,  20-60  min.  (1.3-4.0  c.c). 

Fluidextractum  Zingiberis,  U.  S.  P.     Dose,  10-30  min.    (0.6- 

2  .0  c.c). 

Syrupus  Zingiberis,  U.  S.  P.    Dose,  1/2-43.  dr.  (2.0-15.0  c.c). 

Oleoresina  Zingiberis,  U.  S.  P.     Dose,  1/2-2  min.  (0.03-0.13 

c.c). 

Ginger  is  used  as  a  carminative  and  as  a  flavoring  agent.  It  is  also 
a  constituent  of  the  official  compound  powder  of  rhubarb  and  aromatic 
powder. 

MENTHA  VIRIDIS— U.  S.  P. 

(Spearmint.) 

Spearmint  is  the  leaves  and  tops  of  Mentha  spicata,  a  perennial 
herb  growing  wild  in  the  woods  and  along  the  roadsides  of  Europe  and 
North  America.     Its  official  preparations  are: 

Oleum  Mentha^  Viridis,  U.  S.  P.     Dose,  1-5  min.  (o .  06-0 . 3  c.c.) 

Spiritus  Menthae  Viridis,  U.  S.  P.     Dose,  10-30  min.  (0.6-2.0 

c.c). 

Aqua  Mentha^  Viridis,  U.  S.  P.     Dose,  1-4  fl.  dr.  (4.0-15.0 c.c). 

Therapeutically,  spearmint  is  almost  equivalent  to  peppermint, 
and  is  used  for  practically  the  same  purpose. 

CARDAMOMUM— U.  S.  P. 

(Cardamom.) 

Cardamom  is  the.  fruit  of  Elettaria  repens,  a  perennial  herb,  culti- 
vated in  the  mountainous  portions  of  India.  Its  active  principle  is  a 
volatile  oil,  of  which  it  contains  about  5  per  cent.  The  official  prepara- 
tions are: 

Tinctura  Cardamomi,  U.  S.  P.  Dose,  1-2  fl.  dr.  (4.0-8.0  c.c). 
Tinctura  Cardamomi  Composita,  U.  S.  P.  (contains  also 
Cinnamon,  Caraway,  Cochineal,  and  Glycerin).  Dose,  1-2 
fl.  dr.  (4.0-8.0  c.c). 

Pulvis  Aromaticus,  U.  S.  P.  (Aromatic  Powder;  contains  Car- 
damom, Ginger,  Cinnamon,  and  Nutmeg).  Dose,  10-30  gr. 
(0.6-2.0  gm.). 

Cardamom  also  enters  into  several  of  the  official  aromatic  and  com- 
pound preparations.     It  is  used  as  a  flavoring  agent  and  carminative. 


WISIM      PIMENTA      SASSAFRAS      CARUM.  227 

ANISUM     U.   S.  P. 

Anise.) 

Anise  is  the  small  fruit  of  Pimpinella  anisum,  a  small  plant  culti- 
vated in  southern  Europe  and  North  America.  It  contains  a  volatile 
oil,  having  the  characteristic  odor  of  the  drug,  and  a  sweetish,  aromatic 
taste.     Its  preparations  follow: 

Oleum  Anici.  I".  S.  P.  Dose,  2-5  min.  (0.13-0.3  c.c). 
Spijitus  Anici,  U.  S.  P.  Dose,  1-2  fl.  dr.  (4.0-8.0  c.c). 
Aqua  Anici,  U.  S.  P.     Dose,  2-8  fl.  dr.  (8.0-30.0  c.c). 

The  drug  also  enters  into  many  of  the  official  aromatic  and  com- 
pound preparations.     It  is  used  chiefly  as  a  flavoring  agent. 

PIMENTA— U.   S.  P. 

(Allspice.) 

Allspice  is  the  nearly  ripe  fruit  of  Pimenta  officinalis,  an  evergreen 
tree  growing  in  the  West  Indies  and  South  America.  It  contains  a 
volatile  oil,  the  active  constituent  of  which  is  eugenol.  The  oil  only  is 
official,  which  is  a  constituent  of  spirit  myrcia,  or  bay-rum. 

Oleum  Pimentae,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3  C.C.). 

SASSAFRAS— U.  S.  P. 

Sassafras  is  the  bark  of  the  root  of  Sassafras  variifolium,  a 
shrubby  tree  growing  in  the  woods  of  eastern  and  central  Xorth 
America.  The  pith  is  also  official  (Sassafras  medulla,  U.  S.  P.)  It 
contains  an  aromatic,  fragrant,  volatile  oil  and  tannic  acid. 

The  official  preparations  are: 

Oleum  Sassafras,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3  c.c). 
Mucilago  Sassafras  Medullar,  U.   S.  P.   (2  per  cent.).     Dose, 
1-8  fl.  dr.  (4.0-30.0  c.c). 

Sassafras  oil  also  enters  into  the  official  compound  fluid  extract 
of  sarsaparilla  and  compound  syrup  of  sarsaparilla.  The  mucilage  is 
an  excellent  demulcent  in  cases  of  drug  poisoning,  and  a  tea  made  by 
steeping  the  bark  of  the  root  is  extensively  used  by  the  lay  American  as 
a  "spring  remedy." 

CARUM— U.  S.  P. 

(Caraway.) 

Caraway  is  the  fruit  of  Carum  earvi,  a  native  herb  of  Asia,  but 
cultivated  in  Europe  and  Xorth  America.     Its  active  constituent  is  a 


228  CARMINATIVES. 

volatile  oil.  Caraway  is  used  as  a  flavoring  agent,  and  as  such  it 
enters  into  the  official  compound  tincture  of  cardamom  and  com- 
pound spirit  of  juniper.     The  oil  is  official: 

Oleum  Cari,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3  c.c.) 

FCENICULUM— U.  S.  P. 

(Fennel.) 

Fennel  is  the  fruit  of  Fceniculum  vulgare,  a  plant  growing  chiefly 
in  southern  Europe.  It  contains  an  aromatic  oil.  The  official  prep- 
arations are: 

Oleum  Foeniculi,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3  c.c). 
Aqua  Fceniculi,  U.  S.  P.     Dose,  1-8  fl.  dr.  (4.0-30.0  c.c). 

As  a  flavoring  agent  fennel  enters  into  compound  licorice  powder,  com- 
pound spirit  of  juniper,  and  compound  infusion  of  senna. 

CORIANDRUM— U.  S.  P. 

(Coriander.) 

Coriander  is  the  fruit  of  Coriandrum  sativum,  an  herb  grown  in  all 
parts  of  Europe  and  the  United  States.  It  contains  a  volatile  oil, 
which  is  official. 

Oleum  Coriandri,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3  c.c). 

The  oil  is  used  as  a  flavoring  agent,  and  as  such  it  enters  into  the 
confection  of  senna,  syrup  of  senna,  and  compound  spirit  of  orange. 

FLAVORING  AGENTS. 

Flavoring  agents  are  used  to  mask  the  taste  of  nauseous  drugs,  to 
flavor  foods,  drinks,  etc.     The  chief  flavoring  agents  are: 


Lemon. 

Sarsaparilla.* 

Orange. 

Rose. 

Vanilla. 

Sugar  and  Sugar  of  Milk. 

Lavender. 

Saccharin. 

Honey.* 

LIMON. 

(Lemon.) 

Lemon  is  the  ripe  fruit  of  Citrus  limonum,  a  tree  cultivated  in  most 
semitropical  countries.  The  rind  contains  a  volatile  oil,  and  the 
juice,  citric  acid.     The  following  preparations  are  official: 


AURANTIUM — VANILLA.  229 

Limonis  Cortex,  U.  S.  P.  (Fresh  Rind). 

Limonis  Succus,  U.  S.  P.  (Juice).     Dose,  1-4  fl.  oz.  (30.0-120.0 

c.c). 

Tinctura  Limonis  Corticis,  U.  S.  P.     Dose,  1/2-1  fl.  dr.  (2.0- 

4.0  c.c). 

Oleum  Limonis,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3  c.c). 

Acidum  Citricum,  U.  S.  P.     Dose,  5-20  gr.  (0.3-1.3  gm.). 

Syrupus  Acidi  Citrici,  U.  S.  P.  (1  per  cent.).     Dose,  1-4  fl.  dr. 

(4.0-15.0  c.c). 

The  oil  also  enters  into  other  official  preparations  as  a  flavoring 
agent.  Lemon  juice  has  been  used  in  scurvy,  both  as  a  preventive  and 
curative  agent.  In  the  form  of  cold  lemonade  it  makes  a  pleasant  re- 
frigerant drink.  Hot  lemonade  is  a  useful  remedy  for  colds.  Both  the 
fresh  rind  and  juice  are  used  extensively  as  flavoring  agents. 

AURANTIUM. 

(Orange.) 

There  are  two  varieties  of  orange  :  Sweet  orange,  Citrus  aurantium, 
and  bitter  orange,  Citrus  vulgaris.  The  following  preparations  are 
official: 

Aurantii  Amari  Cortex,  U.  S.  P.     Dose,  15-30  gr.  (1 . 0-2 .  o  gm.). 

Fluidextractum  Aurantii  Amari,  U.  S.  P.     Dose,  1/2-1  fl.  dr. 

(2.0-4.0  c.c). 

Tinctura  Aurantii  Amari,  U.  S.  P.     Dose,  1-2  fl.  dr.  (4.0-8.0 

c.c). 

Aqua  Aurantii  Florum,  U.  S.  P.     Dose,  indefinite. 

Aqua  Aurantii  Florum  Fortior,  U.  S.  P. 

Syrupus  Aurantii  Florum,  U.  S.  P.     Dose,  indefinite. 

Auranti  Dulcis  Cortex,  U.  S.  P.     Dose,  15-30  gr.  (1.0-2.0  gm.). 

Tinctura  Aurantii  Dulcis,  U.  S.  P.     Dose,  1-2  fl.  dr.  (4.0-8.0 

c.c). 

Syrupus  Aurantii,  U.  S.  P.     Dose,  indefinite. 

Oleum  Aurantii  Cortex,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3  c-c0 

Syrupus   Aurantii    Compositus,    U.    S.    P.     Dose,    1-4   fl.    dr. 

(4.0-15.0  c.c). 

Elixir  Aromaticum,  U.  S.  P.     Dose,  1-4  fl.  dr.  (4.0-15.0  c.c). 


Both  varieties  of  orange  are  used  almost  exclusively  as  flavoring 


agents. 


VANILLA. 


Vanilla  is  the  fruit  of  Vanilla  planifolia,  a  perennial  climbing 
plant,  native  of  the  West  Indies  and  tropical  America.  Its  charac- 
teristic odorous  principle  is  vanillin.     The  tincture  is  official: 


230  CARMINATIVES. 

Tinctura  Vanillae,  U.  S.  P.  (10  per  cent.).     Dose,  a  few  minims, 
according  to  the  strength  of  flavor  desired. 

Vanilla  is  employed  chiefly  as  a  perfume  and  as  a  flavoring  agent. 


LAVANDULA. 

(Lavender.) 

Lavender  is  the  flowers  of  Lavandula  officinalis,  a  native  shrub 
of  southern  Europe.  It  contains  a  fragrant  volatile  oil,  tannic  acid, 
and  resin.     The  official  preparations  are: 

Oleum  Lavandulae  Florum,  U.  S.  P.     Dose,  1-5  min.  (0.06-0.3 

c.c). 

Spiritus  Lavandulae,  U.  S.  P.     Dose,  1/2-1  fl.  dr.  (2.0-4.0  c.c). 

Tinctura  Lavandulae  Composita,  U.  S.  P.     Dose,  1/2-1  fl.  dr. 

(2  .0-4.0  c.c). 

The  compound  tincture  is  also  an  ingredient  of  Fowler's  solution. 
The  preparations  of  the  drug  are  used  only  for  their  agreeable  flavor. 

ROSA  GALLIC  A— U.  S.  P. 

(Rose.) 

Rose  is  the  dried  petals  of  Rosa  gallica,  a  species  of  red  rose  culti- 
vated extensively  in  western  Asia  and  southern  Europe.  It  contains 
a  volatile  oil,  tannic  acid,  sugar,  and  mucilage.  The  official  oil  of  rose 
is  distilled  from  the  fresh  flowers  of  the  Damascus  rose  (Rosa  damas- 
cena.)     The  following  are  its  official  preparations: 

Fluidextractum  Rosae,  U.  S.  P. 

Syrupus  Rosae,  U.  S.  P.  (12.5  per  cent,  of  the  fluid  extract). 

Mel  Rosae,  U.  S.  P.   (12.5  per  cent,  of  the    fluid   extract    in 

clarified  Honey). 

Confectio  Rosae,  U.  S.  P.  (Red  Rose,  8;  Sugar,  64;  Honey,  12; 

Stronger  Rose  Water,  16.) 

Oleum  Rosae,  U.  S.  P.  (Attar  of  Rose). 

Aqua  Rosae  Fortior,  U.  S.  P.  (Water  saturated  with  oil  of  Rose). 

Aqua  Rosae,  U.  S.  P.  (equal  parts  of  Stronger  Rose  Water  and 

Distilled  Water). 

Preparations  of  rose  also  enter  into  several  official  preparations 
as  flavoring  agents.  The  ointment  of  rose  water  (cold  cream)  makes 
an  excellent  application  for  the  hands  and  face.  A  splendid  lotion 
for  the  hands  is:  Phenol  (95  per  cent.)  6  min.  (0.36  c.c);  borax, 
1/2  dr.  (2.0  gm.);  rose  water,  and  glycerin,  of  each  1  1/2  fl  oz.  (45.0  c.c). 


SACCIIARI  M    AND    SACCHARUM    LACTIS.  231 

SACCHARUM --U.  S.  P.  AND  SACCHARUM  LACTIS     U.  S.  P. 
(Cane  Sugar;  Sllgai  and   Sugar  of  Milk;   Lad' 

Cane-sugar  is  refined  from  sugar-cane,  Saccharum  officinarum, 
from  various  species  of  broom-corn.  Sorghum,  and  from  one  or  more 
varieties  of  Jugar-beet,  Beta  vulgaris.  A  saturated  solution  is 
official  as: 

Syrupus,  CJ.  S.  P.  (Simple  Syrup). 

Sugar  enters  as  a  flavoring  agent,  preservative,  vehicle,  orexcipient 
into  many  official  compound  preparations.  Sugar  of  milk  is  the 
sugar  obtained  from  the  whey  of  cow's  milk.  It  is  harder,  less  soluble, 
and  less  sweet  than  ordinary  sugar,  and  is  largely  used  as  a  diluent 
for  powders,  as  in  Dover's  powder. 

BENZOSULPHINIDUM— U.  S.  P 

(Benzosulphinid;  Saccharin.) 

Saccharin  is  obtained  from  the  coal-tar  derivative,  toluene.  It 
occurs  in  a  light,  white,  crystalline  powder,  odorless,  and  possessing 
500  times  the  sweetening  power  of  cane-sugar.  It  is  soluble  in  250 
parts  of  water,  more  so  in  alcohol  or  glycerin,  and  readily  soluble  in 
alkaline  solutions. 

Saccharin  is  used  as  a  flavoring  agent  for  mouth-washes,  tooth- 
pastes, tooth-powders,  etc.  Internally,  in  large  doses,  it  retards  diges- 
tion and,  therefore,  metabolism. 


REMEDIES  OTHER  THAN  DRUGS. 

The  object  sought  in  all  therapeutics  is  simply  to  assist  Nature  in 
her  efforts  to  ward  off  disease  and  to  restore  an  abnormal  to  a  normal 
condition.  In  dental  therapeutics  this  gives  to  the  resourceful  dentist 
a  wide  range  of  activity.  There  are  several  means  of  combating 
disease  other  than  by  the  use  of  drugs.  Those  deserving  mention 
will  briefly  be  discussed  here.     They  are: 

Heat.  Electricity. 

Cold.  Massage. 

Compressed  Air.  Suction. 

Light.  Suggestion. 

HEAT. 

Heat  is  a  useful  therapeutic  agent.  It  is  largely  employed  locally 
in  dentistry  and  is  applied  in  both  the  dry  and  moist  forms.  Dry  heat  is 
applied  by  means  of  hot  cloths,  bran-bags,  water-bags  or  water-bottles, 
or  superheated  dry  air.  Moist  heat  may  be  applied  by  means  of 
fomentations,  poultices,  or  the  hot-water  syringe.  Hot-water  baths 
are  also  applicable  to  certain  limited  portions  of  the  body,  as  the  feet, 
and  are  used  for  counterirritant  purposes.  Locally  applied,  heat 
allays  irritation  of  the  peripheral  sensory  nerves,  dilates  the  cutaneous 
vessels,  increases  perspiration,  and,  like  cold  and  counterirritation, 
doubtless  exerts  a  favorable  influence  on  the  subjacent  structures. 

The  general  application  of  heat  may  be  obtained  by  means  of  the 
hot-water  bath,  hot  pack,  hot-vapor  bath,  or  hot  blankets.  In  the 
Russian  bath  steam  replaces  the  hot-dry  air  of  the  Turkish  bath.  The 
first  effects  of  the  general  application  of  heat  are  free  perspiration, 
resulting  from  the  dilatation  of  the  cutaneous  vessels. 

Moist  external  heat  is  used  for  a  variety  of  diseases,  especially 
subacute  and  chronic  rheumatism.  Dry  external  heat  may  be  employed 
in  many  cases  of  drug  poisoning,  one  symptom  of  which  is  that 
characteristic  cold,  clammy  sweat. 

Moist  heat  is  used  locally  in  pericementitis,  in  acute  alveolar  abscesses 
accompanied  by  pain  and  swelling,  and  many  other  dental  conditions. 
Dry  heat  is  chiefly  used  in  dentistry  for  drying  tooth-structure  and 
obtunding  sensitive  dentin.     For  this  purpose  many  apparatuses  have 

232 


ill  \i      COLD.  233 

been  devised  for  heating  dry  air.  Properly  shaped  wire,  for  root- 
canal  work,  may  be  heated  and  used. 

Heat  is  also  employed  to  the  extent  of  actual  destruction  of  tissue 
in  vesication  and  cauterization.  The  thermocautery  and  galvano- 
cautery  are  exceedingly  valuable  as  counterirritant,  revulsive,  and 
hemostatic  measures. 

Thermometric  Scale. — For  determining  the  temperature,  the 
Fahrenheit  scale  is  in  ordinary  use  in  America  and  England;  the 
centigrade  is  used  on  the  European  continent;  the  latter  scale  is  also 
largely  used  in  the  sciences.  The  freezing-point  of  water  with  the 
Fahrenheit  scale  is  320  above  zero;  with  the  centigrade  scale  it  is  at 
zero.  The  boiling  point  of  water  with  the  Fahrenheit  scale  is  2120. 
This  minus  the  32°equals  1800  above  zero.  The  boiling-point  of  water 
with  the  centigrade  scale  is  100°  Therefore,  stated  in  terms  of  propor- 
tion: ioo°C  :  i8o°F::5  :  9,  hence  the  following  simple  rules  for  convert- 
ing the  degrees  of  one  scale  into  the  other. 

To  Convert  Degrees  of  the  Fahrenheit  Scale  into  those  of  Centi- 
grade: If  the  temperature  be  above  the  freezing-point  (320),  subtract 
32;  if  it  be  below  the  freezing-point,  subtract  the  number  from  32, 
algebraically;  then  multiply  the  remainder   by  5  and   divide   by   9. 

To  Convert  Degrees  of  the  Centigrade  Scale  into  those  of  Fahren- 
heit: Multiply  the  number  of  the  former  by  9  and  divide  by  5;  if  the 
temperature  be  above  the  freezing-point  (o°),  add  32;  if  it  be  below  the 
freezing-point,  subtract  the  result  from  32,  algebraically. 

COLD. 

Cold,  like  heat,  may  be  used  either  locally  or  generally  as  a  thera- 
peutic agent.  It  is  the  local  application  of  the  remedy  with  which 
dentists  are  mostly  concerned.  It  may  be  locally  applied  by  means  of 
cloths  wrung  out  of  iced  water,  an  ice-bag,  an  ice-poultice,  etc.  As 
cold  is  but  a  lesser  degree  of  heat,  the  latter  may  be  abstracted  and  cold 
produced  by  spraying  the  part  with  a  highly  volatile  liquid,  like  ethyl 
chlorid,  ether,  etc. 

Local  applications  of  cold  abstract  heat  from  the  part,  lessen  the 
sensibility  of  the  peripheral  nerve-endings,  cause  contriction  of  the 
blood-vessels  traversing  the  tissues  exposed  to  the  cold,  and  affect, 
reflexly,  the  vascularity  of  the  structures  subjacent  to  the  site  of 
application. 

The  general  application  of  cold  to  the  body  may  be  accomplished 
in  several  ways:  By  cold-water  bath,  cold  sponge-bath,  cold  pack,  or 
the  cold  douche.     When  followed  by  vigorous  rubbing  with  a  Turkish 


234  REMEDIES    OTHER    THAN    DRUGS. 

towel,  cold  bathing  exerts  a  powerful  tonic  effect.  It  sharpens  the 
appetite,  aids  digestion,  promotes  metabolism,  and  greatly  favors  the 
elimination  of  waste  products. 

Cold  is  employed  for  a  variety  of  purposes  in  the  treatment  of 
disease.  In  dentistry  it  is  used  as  a  counterirritant  in  acute  alveolar 
abscess,  in  pericementitis,  neuralgia,  and  other  conditions.  As  a  refriger- 
ant local  anesthetic,  cold  may  be  obtained  by  the  use  of  ether,  or 
combinations  containing  it,  and  ethyl  chlorid,  both  used  as  sprays.  In 
this  manner  cold  is  used  in  lancing  abscesses,  obtunding  sensitive 
dentin,  extracting  loose  teeth,  etc. 

COMPRESSED  AIR. 

Compressed  air  is  one  of  the  most  convenient  agents  in  the  modern 
dental  office.  While  in  itself  it  may  not  be  considered  a  therapeutic 
agent,  except  as  a  vehicle  for  applying  heat  or  cold,  it  is,  nevertheless,  a 
valuable  adjunct  to  the  use  of  many  such  agents.  For  drying  a  sensi- 
tive cavity,  clearing  away  the  "chips,"  and  lessening  the  pain  of  drilling, 
it  has  no  equal  (see  p.  263).  In  treating  pyorrhea  alveolaris  it 
serves  a  useful  purpose.  By  its  employment  the  pocket  may  be  kept 
dry  sufficiently  long  for  the  operator  to  see  in  many  cases  whether  or 
not  the  deposits  have  been  thoroughly  removed.  It  may  be  used  as  the 
force  for  spraying  solutions  all  through  the  operation;  and  when  the 
teeth  are  scaled  and  polished  the  field  maybe  kept  dry  by  the  use  of  com- 
pressed air  while  the  astringent  remedy  is  applied.  The  resourceful 
dentist  will  find  many  uses  for  the  agent. 

LIGHT. 

Light  is  a  form  of  energy  which  has  recently  been  brought  forth 
as  having  a  peculiarly  favorable  effect  upon  diseased  tissues  of  the 
body,  and  is  employed  to-day  for  a  variety  of  purposes  in  therapeutics, 
both  general  and  dental.  The  blue  light,  lucodescent  light,  and 
other  forms  are  used.  The  mode  of  action  is  not  well  understood. 
Extravagant  claims  are  being  made  for  the  lucodescent  light,  but  it  is 
thought  by  many  that  the  real  virtue  lies  in  the  soft  penetrating  heat 
produced.  It  may  prove  to  be  a  practical  means  of  applying  heat 
which  has  long  been  recognized  as  a  therapeutic  agent.  Reliable 
evidence  has  thus  far  been  lacking  to  prove  that  the  light  has  an  action 
upon  the  tissues  other  than  through  the  heat  generated.  The  blue 
light  has  been  suggested  for  obtunding  sensitive  dentin,  and  is  obtained 
in  one  way  by  passing  the  ray  through  blue  glass.  A  blue  bulb  (16  or 
32  c.  p.)  is  used  on  an  ordinary  electric  socket.     The  room  is  darkened 


RON  K.I  A    OB    X   RAY.  235 

and  the  patient  requested  to  look  at  the  light  which  is  held  from  sis 
inches  to  one  foot  from  the  eyes.  Whether  the  light  acts  locally  or 
affects  the  vision  and  thus  the  general  nervous  system  has  yet  to  be 
determined.  The  author's  experience  with  light  thus  far  has  not  been 
encouraging.  It  is  true,  however,  that  light  differs  in  effect  from  heat, 
though  both  come  from  the  same  heated  body.  This  phenomenon  is 
observed  in  the  action  of  light  on  certain  chemicals;  for  example,  the 
silver  salts  undergo  a  chemic  change  when  exposed  to  sunl'ght  or 
luminously  hot  bodies.  For  this  reason  it  has  been  suggested  by 
Black  and  others  to  expose  the  tooth-surface  treated  with  silver  nitrate 
to  the  sunlight,  if  possible.  The  author  finds  a  more  practical  way  of 
accomplishing  the  change  in  the  decomposition  of  the  salt  by  using  the 
small  electric  mouth-lamp.  Light  from  a  small  electric  mouth-lamp 
serves  almost  as  a  positive  means  of  diagnosing  a  dead  pulp  in  a  tooth 
where  the  color  is  practically  normal;  it  also  aids  materially  in  con- 
firming the  diagnosis  of  obscure  antrum  involvement. 

It  is  to  be  hoped  that  further  investigation  may  be  made  with 
light  as  a  therapeutic  agent  that  its  action  may  be  better  understood, 
for  it  seems  to  possess  sufficient  merit  to  justify  such  investigation. 

Rontgen  or  X-ray. — The  Rontgen  or  X-ray  has  been  employed 
extensively  in  both  general  and  dental  therapeutics;  in  dentistry  it 
is  largely  used  for  diagnostic  purposes.  By  means  of  the  skiagraph 
(an  X-ray  picture)  the  diagnosis  of  the  following  conditions  may  be 
confirmed: 

1.  Fracture  of  the  jaw  and  the  relation  of  the  fragments. 

2.  Fracture  and  dislocation  of  the  teeth  in  the  jaw. 

3.  Alveolar  abscess:  involving  more  roots  than  one;  in  relation  to  the 
nasal  cavity;  in  relation  to  the  maxillary  antrum  (antrum  of  Highmore). 

4.  Impacted  and  noncrupted  teeth;  as  to  the  cause  of  neuralgic 
conditions,  and  in  point  of  treatment,  extraction,  etc. 

5.  Pulp-nodules,  pulp-calcijicatian,  and  secondary  dentin. 

6.  Cementosis. 

7.  Foreign  bodies  in  the  maxillary  antrum. 

8.  Broken  broach  in  tooth -root. 

There  are  other  conditions  in  dental  practice  wherein  the  X-ray 
aids  materially  in  arriving  at  a  correct  diagnosis.  Much  credit  is 
due  to  Kells,  Price,  Shamburg,  Lewis,  and  others  for  developing 
skiagraphy  in  dentistry. 

The  X-ray  treatment  has  been  found  extremely  valuble  in  super- 
ficial cancer,  lupus  vulgaris,  and  acne.  It  has  also  been  employed  in 
the  treatment  of  pyorrhea  alveolaris  with  varying  results.  The  power- 
ful actinic  properties  of  this  modified  form  of  light  are  illustrated  by 


236  REMEDIES  OTHER  THAN  DRUGS. 

the  fact  that  several  deaths  and  many  injuries,  such  as  burns, 
necessitating  amputation  in  some  cases,  have  been  traced  to  the  long- 
continued  exposure  of  the  X-ray. 

The  method  devised  by  Finsen  of  concentrating  rays  of  either 
sunlight  or  electric  arc-light  has  met  with  more  or  less  success  in  the 
treatment  of  lupus  vulgaris  and  other  skin  diseases,  but  it  has  not 
been  utilized  in  dentistry  to  any  extent. 

Radium. — The  salts  of  radium  (bromid  and  chlorid)  give  out 
three  kinds  of  rays,  known  as  alpha,  beta,  and  gamma  rays.  The 
therapeutic  uses  of  radium  rays  have  been  shown  to  follow  practically 
the  same  lines  as  those  of  the  X-ray,  but  they  are  generally  considered 
less  useful.  At  the  present  time  the  use  of  radium  rays  is  only  in  the 
experimental  stage  and  no  positive  evidence  is  at  hand  to  prove  their 
superior  value.  They  require  the  same  careful  handling  as  the  X-ray, 
as  they  are  capable  of  producing  severe  burns  and  even  deep-seated 
ulcers. 

ELECTRICITY. 

Electricity  is  used  as  a  therapeutic  agent  itself,  as  well  as  a  carry- 
ing medium  for  drugs  (cataphoresis),  and  for  purposes  of  diagnosis 
and  prognosis.  Two  currents  are  employed,  the  primary  or  galvanic 
and  the  induced  or  faradic,  the  battery  furnishing  the  current  being 
supplied  with  a  positive  pole,  or  anode,  and  a  negative  pole,  or  cathode. 
When  the  electric  current  is  passed  through  a  muscle  it  causes  con- 
traction of  the  latter.  As  a  muscle  degenerates  it  gradually  loses  its 
electrocontractility,  the  response  to  the  faradic  current  disappearing 
first,  while  the  galvanic  current  produces  contraction  for  some  time 
longer,  until  finally  no  current  will  produce  any  effect. 

Electricity  is  used  as  a  muscle  and  nerve  stimulant  for  a  variety 
of  conditions,  such  as  in  the  so-called  idiopathic  forms  of  neuralgia, 
in  neurasthenia,  hysteria,  etc.  In  poisoning  by  opium  and  other  narcotics 
a  strong  faradic  current  often  affords  a  means  of  arousing  the  patient 
without  increasing  the  exhaustion  or  causing  any  ill  effects.  In  dental 
therapeutics,  perhaps,  the  greatest  use  of  electricity  has  been  in  con- 
nection with  a  method  of  treatment  called  cataphoresis. 

Cataphoresis. — This  is  a  term  applied  to  the  process  of  carying 
medicinal  agents  in  solution  into  the  various  tissues  and  organs  of  the 
body  by  means  of  the  electric  current.  It  is  used  chiefly  for  obtunding 
sensitive  dentin  and  for  the  purpose  of  anesthetizing  the  pulp  to  facilitate 
its  painless  removal  (see  p.  284). 


MASSAGE — SUCTION.  237 


MASSAGE. 


Massage  is  ;i  term  used  to  designate  methodical  kneading, 
rubbingj  and  percussion  of  the  body.  The  person  practising  massage 
is  known  as  a  masseur  (male)  or  masseuse  (female).  The  efficacy  of 
proper  massage  in  many  pathologic  conditions  can  no  longer  be 
doubted.  It  acts  as  a  stimulant  to  both  nerve  and  muscle  and  to 
many  of  the  bodily  functions,  assisting  circulation  and  favoring  the 
elimination  of  waste-products.  Massage  is  employed  in  dentistry 
for  both  its  local  and  systemic  effects  in  neuralgia,  pyorrhea  alveolaris, 
edemas  resulting  from  alveolar  abscess  and  other  conditions;  in  medicine 
it  is  used  in  rheumatism,  paralysis,  synovitis,  sprains,  and  fractures. 
In  the  "rest  cure"  of  Mitchell  it  is  combined  with  isolation,  rest,, 
forced  feeding,  and  faradism.  It  is  also  used  for  its  general  effect  in 
neurasthenia,  nervous  prostration,  and  hysteria. 

SUCTION. 

The  method  of  producing  hyperemia  in  a  part  by  means  of 
suction  for  the  purpose  of  combating  disease  is  fast  gaining  recognition 
in  medicine,  and  it  has  been  employed  also,  to  some  extent,  in  dentistry. 

When  some  noxious  influence  acts  on  a  more  or  less  limited  area 
of  the  body,  local  resistance  is  manifested  by  the  production  of  granula- 
tion tissue  and  of  hyperemia.  Under  favorable  circumstances  the 
granulation  tissue  repairs  defects  resulting  from  the  noxa,or  more  or  less 
completely  encapsulates  the  irritating  agent.  Under  less  favorable 
circumstances,  the  irritation  being  continuous,  e.  g.,  in  tuberculous  in- 
fection, granulomata  are  formed,  these  granulomata  being  evidence  of 
defense.  If  the  resisting  power  is  sufficient,  the  embryonic  tissue  over- 
comes the  irritant  and  incloses  it  in  fully  developed  scar  tissue.  Stimu- 
lation of  the  production  of  granulation  in  and  around  a  tuberculous 
focus  seems  to  be  the  therapeutic  action  of  injections  of  emulsions  con- 
taining iodoform,  bismuth,  finely  divided  carbon,  etc.,  and  of  sclero- 
genic  injections. 

The  second  method  by  which  nature  resists  a  noxa  (or  infection) 
is  by  hyperemia.  When  an  irritant,  e.g.,  the  staphylococcus,  gains 
access  to  the  tissues,  the  flow  of  blood  to  the  part  becomes  increased, 
there  is  exudation  of  fluids  and  leucocytes  from  the  vessels  into  the 
tissues.  The  blood  serum  contains  antibodies  or  antitoxins  which 
neutralize  the  chemic  products  of  bacterial  activity;  bacterial  agents 
which  attack  the  bacteria  themselves;  opsonins  which  prepare  the  bac- 
teria for  absorption  and  destruction  by  phagocytes,  or  perhaps  act  as 
a  sort  of  appetizer  to  the  phagocytes,  and  lastly  there  are  the  leucocytes 


238  REMEDIES    OTHER    THAN    DRUGS. 

which  act  as  phagocytes,  directly  killing  bacteria  or,  as  scavengers,  re- 
moving the  debris  of  the  fight.  Thus,  while  the  granulation  tissue  acts 
as  a  sort  of  passive  role  besieging  the  invading  irritant,  the  hyperemia 
directly  and  actively  combats  it  (Binnie).1 

The  suction  method  of  producing  hyperemia  cannot  but  prove 
efficacious  in  the  treatment  of  certain  forms  of  alveolar  abscess  and 
pyorrhea  alveolaris.  It  now  remains  for  some  ingenious  dentist  to 
devise  a  practical  appliance  by  which  dental-applications  can  be  made, 
and  much  good  will  surely  result  from  this  method  of  assisting  nature 
in  her  efforts  to  restore  an  abnormal  to  a  normal  condition.  Keefe  has 
applied  suction  in  the  treatment  of  pyorrhea  alveolaris  with  good  re- 
sults by  taking  an  impression  in  wax,  removing  and  cutting  the  wax 
from  around  the  imprints  of  the  teeth,  thus  creating  a  space  from 
which  the  air  can  be  withdrawn,  after  reinserting  the  impression,  by 
means  of  a  large  bulb  or  syringe  attached  to  a  tube  leading  through  the 
impression  tray  and  into  the  space. 

The  former  application  of  the  leech,  called  leeching,  was  something 
on  this  same  principle,  but  the  practice,  especially  in  dental  therapeu- 
tics, is  gradually  growing  obsolete. 

SUGGESTION. 

Suggestion,  as  used  in  therapeutics,  is  the  method  of  employing 
faith  or  confidence  in  the  treatment  of  disease.  There  is  no  doubt  but 
what  faith  is  one  of  the  oldest  therapeutic  agents  known.  Guerini 2  re- 
fers to  the  confidence  placed  in  the  power  of  the  ancient  priests  to  cure 
the  sick,  and  how  to  maintain  this  confidence  the  latter  gradually  worked 
into  the  administration  of  infusions  and  decoctions  made  from  fresh 
herbs,  etc.  With  all  peoples,  from  the  earliest  centuries  to  the  present 
day,  suggestion  has  ever  been  active.  Where  the  disease  is  purely 
functional,  and  not  organic,  the  influence  which  the  mind  can  be  made 
to  exert  over  the  body  is  a  potent  factor  in  the  treatment  of  the  condi- 
tion, whether  it  be  called  psychotherapy,  mental-healing,  Christian 
Science,  or  by  some  other  name. 

Hypnotism  is  practised  by  many  dentists  as  a  means  of  preventing 
pain  and  controlling  patients.  Confidence  is  an  important  factor  in 
dental  practice.  The  dentist  should  ever  strive  to  gain  the  confidence 
of  his  patients,  be  they  young  or  old,  and  when  obtained  he  should  con- 
stantly guard  against  abusing  it  by  careless  and  indifferent  methods  of 
operating. 

1  Journal  of  the  American  Medical  Association. 
3  History  of  Dentistry. 


METROLOGY. 

Metrology  is  the  science  that  treats  of  the  gravitating  force  of  a 
body  called  weight;  its  extension,  bulk,  or  volume,  called  measure, 
and  the  relation  of  these  to  each  other  called  specific  gravity. 

In  pharmacy,  liquids,  as  a  rule,  are  measured,  while  solids  are 
weighed;  however,  certain  liquids  are  required  to  be  weighed.  The 
difference  between  measuring  and  weighing  some  liquids  is  not  great, 
while  with  others  it  is  considerable,  and  if  this  difference  is  not  consid- 
ered, varying  results  frequently  follow.  This,  of  course,  is  due  to 
the  different  specific  gravity  of  the  liquids  (e.g.,  chloroform  is  heavy 
while  alcohol  is  light). 

The  systems  of  weight  in  the  United  States  are  Avoirdupois  and 
Apothecaries',  or  Troy. 

The  United  States  Pharmacopeia,  in  all  of  its  editions  previous 
to  1880,  adopted  the  Apothecaries'  weight  as  the  official  standard. 
In  1880  the  parts-by-weight  system  was  adopted.  During  the  ten 
years  of  its  official  life  this  system  never  became  popular,  owing  to  the 
difficulty  of  having  to  weigh  all  liquids,  regardless  of  their  specific 
gravity.  However,  its  adoption  at  this  time  paved  the  way  for  the 
adoption  of  the  Metric  System  in  1890,  and  again  in  the  eighth  decen- 
nial revision  of  the  U.  S.  P.,  in  1900.  The  metric  system,  therefore,  is 
now  the  official  standard.  Nevertheless,  although  not  officially 
sanctioned,  the  apothecaries'  weight  still  remains  in  common  use 
in  prescribing  medicines,  owing  to  the  ease  with  which  it  can  be  sub- 
divided into  simple  fractions.  Throughout  this  work  the  apothe- 
caries' weight  has  been  given  the  preference,  the  metric  equivalent 
being  enclosed  in  parenthesis.  One  troy  ounce,  equal  to  480  grains, 
is  easily  divided  by  any  even  number — 2,  4,  8,  etc.  This  quality  is 
of  great  practical  value  to  the  dispenser  and  prescriber  alike.  For 
the  latter  it  simplifies  prescription-writing  because  of  its  easy  division; 
the  quantity  of  a  remedy  required  for  administration  may  be  com- 
puted with  the  measure  of  the  solvent  very  quickly  in  simple  fractions 

The  fluid  measure  used  in  pharmacy  can  always  be  reduced  to 

239 


240  METROLOGY. 

drams — the  equivalent  of  a  teaspoonful.  This  being  the  measure 
ordinarily  used  in  administering  medicines,  the  quantity  of  a  dose  is 
readily  ascertained.  When,  for  example,  30  grains  of  potassium 
iodid  in  one  fluidounce  of  compound  syrup  of  sarsaparilla  is  pre- 
scribed, with  directions  "one  teaspoonful  at  a  dose,"  it  is  readily  com- 
puted that  the  quantity  of  potassium  iodid  in  each  dose  must  be 
3  3/4  gr.,  since  one  fluidounce  contains  eight  fluidrams,  or  tea- 
spoonfuls.  The  tables  for  the  various  systems  of  weight  and  measure 
are  here  given: 

Troy,  or  Apothecaries'  Weight. 

20  grains  (gr.)  =1  scruple  O)  =     20  grains. 

3  scruples  =1  dram  (5)  =     60  grains. 

8  drams  =1  ounce  (o)  =  480  grains. 

12  ounces  =1  pound  (rb.^5760  grains. 

Wine,  or  Apothecaries'  Measure. 

60  minims  (rr[)  =1  fluidram        (f  5). 

8  fluidrams  =1  fluidounce     (f  §)• 

16  fluidounces  =  1  pint  (O). 

2  pints  =1  quart  (qt.). 

4  quarts  =1  gallon  (Cong.,  C.)  =231  cubic  inches. 

A  fluidounce  of  water  at  its  maximum  density  (40  C.)  weighs 
456-37  grains. 

Avoirdupois  Weight. 

1  ounce  (av.  oz.)  =437.5  grains. 

16  ounces  =  1  av.  tb. 

1  pound  =7,000  grains. 

The  odd  number  of  grains  in  the  avoirdupois  ounce,  as  compared 
with  the  round,  easily  divided  number  of  grains  of  the  apothecaries' 
ounce,  is  due  to  the  fact  that  in  the  latter  system  the  unit  is  the  ounce, 
and  from  this  the  pound  was  formed.  In  the  former  the  pound  is 
the  unit,  which  divided  by  16  gives  an  ounce  containing  only  437.5 
grains,  as  against  480  grains  in  the  apothecaries'  ounce.  £-  I 

The  troy  or  apothecaries'  weight  is  used  in  the  compounding 
of  prescriptions;  the  wine  or  apothecaries'  measure  is  used  for  meas- 
uring liquids  in  pharmaceutic  work,  and  the  avoirdupois  weight  is 
in  common  use  generally.  The  troy  and  avoirdupois  pounds  are 
abbreviated  in  the  same  manner,  lb.,  but  differ  in  the  number  of  grains 
contained  (5,760,   7,000).     The  Troy  pound  is  rarely  used,  and  the 


I  III.    MI.IKIC    SYSTEM.  24 1 

use  of  the  scruple  (3)  is  practically  obsolete;  it  is  just  as  convenient 
to  write  for  20  grains,  and  there  is  less  likelihood  of  a  mistake,  for  the 
abbreviation  for  scruple  may  be  taken  for  a  carelessly  written  dram 
mark. 

Approximate  Fluid  Measures. 

Teaspoonful         ^foj 
Dessertspoonful  =foij 
Tablespoonful      =  f.~iv 
YVineglassful         =  f5ij 
Teacupful  =f5iv 

One  cubic  inch  of  distilled  water,  at  its  maximum  density,  a  tem- 
perature of  40  C.  in  vacuo,  weighs  252.892  gr.,  and  231  cubic  inches  is 
a  measure  equivalent  to  the  U.  S.  gallon.  The  gallon  is  divided  into 
8  pints;  1  pint  into  16  fluidounces;  1  fluidounce  into  8  fluidrams, 
and  1  fluidram  into  60  minims.  The  measure  of  volume  may,  there- 
fore, always  be  compared  with  the  weight  of  water  as  above,  the  stand- 
ard for  comparison,  thus: 

One  cubic  ^11  =  252.892;  252.892  X231  =58,418  gr.  =  1  gallon. 
58,418-7-8      =  7,302  grains   =  1  pint. 

7,302-7-16   =456.37  grains  =  1  fluidounce. 
456.37-4-480=     0.95  grains  =  1  minim. 

For  all  practical  purposes  a  minim  may  be  considered  the  equivalent 
of  a  grain  (1  min.  =0.95  gr.).  A  drop  is  not  a  minim,  although  gener- 
ally considered  its  equivalent,  and  the  measurement  of  liquids  by  drops 
does  not  give  uniform  and  accurate  results.  The  size  of  drops  varies 
greatly  with  different  liquids;  also  with  the  same  liquids,  according 
to  the  conditions  governing  the  process  of  dropping.  Among  these 
conditions  may  be  mentioned: 

1.  The  quantity  of  the  liquid  contained  in  the  vessel. 

2.  The  size  and  shape  of  the  lip  of  the  vessel. 

3.  The  rapidity  of  the  dropping. 

4.  The  temperature  and  character  of  the  liquid. 

THE  METRIC  SYSTEM. 

The  metric  system  of  weights  and  measures  was  first  introduced  in 

France  at  the  close  of  the  eighteenth  century;  hence  it  is  often  called 

the  French  system.     Owing  to  its  decimal  parts,  it  is  frequently  termed 

also  the  decimal  system.     This  system  has  gradually  displaced  all  the 

16 


242  METRIC    SYSTEM. 

various  systems  of  weights  and  measures  throughout  the  European 
continent,  and  is  the  only  recognized  system  in  all  countries  except 
Russia,  Great  Britain  and  her  colonies,  and  the  United  States  of  Amer- 
ica. For  this  reason  the  metric  equivalent  has  been  given  for  quantities 
throughout  this  work. 

Hallberg  states  that  because  of  its  simplicity  in  construction,  regularity  and 
convenience  in  exact  calculations,  it  has  become  the  only  system  for  scientific  work, 
and  is  no  doubt  destined  to  soon  displace  the  older  systems  in  art  and  commerce 
throughout  the  civilized  world.  Through  our  system  of  decimal  numbering — ones, 
tens,  hundreds,  thousands,  etc. — the  monetary  systems  of  all  civilized  nations,  ex- 
cept Great  Britain,  have  also  become  decimal  and  brought  with  them  the  metric 
system. 

The  functions  of  money  and  weights  and  measures  are  so  intimately  related 
and  interdependent  that  a  decimal  system  in  one  practically  demands  a  decimal 
system  of  the  other.  The  decimal  system  of  money  was  one  of  the  privileges 
accorded  the  people  of  the  United  States  by  early  adoption,  but  while  adopting 
this  great  improvement  over  the  old  English  pound,  shilling,  and  pence,  the  old 
English  weights  and  measures,  based  on  the  penny-system,  were  unfortunately 
retained. 

Although  the  U.  S.  Government,  in  1867,  made  the  metric  system 
obligatory  in  the  three  branches  of  its  medical  service — the  Army,  Navy, 
and  Marine  Hospital — and  also  legally  permissible  throughout  the 
Union,  all  efforts  to  make  it  obligatory  in  the  various  States  have  so  far 
failed.  It  is  difficult  to  change  a  long-established  custom,  but  it  does 
seem  that  there  is  little  excuse  for  not  adopting  the  metric  system 
generally  in  the  United  States  with  our  decimal  proportions  of  the  dollar, 
the  dime,  and  the  cent,  based  upon  exactly  the  same  principle. 

The  metric  system  is  based  upon  the  meter,  which  is  the  standard 
unit  of  linear  measure,  being  the  ten-millionth  part  of  one-fourth  of  the 
circumference  of  the  earth  (the  quadrant).  It  is,  therefore,  the  one 
forty-millionth  part  of  the  entire  circumference  of  the  earth  taken 
around  the  poles,  measured  by  the  meridian  and  not  by  the  equator. 

One  meter  is  equal  to  39.37  inches. 

The  liter  is  the  unit  of  liquid  measure,  and  is  the  cube  of  one-tenth 
of  the  meter,  or  cubic  decimeter,  and  one-thousandth  part  of  it,  or  the 
cube  of  one-hundredth  of  the  meter  is  one  cubic  centimeter. 

The  unit  of  weight  is  the  gramme  or  gram,  the  weight  of  one  cubic 
centimeter  of  pure  water  in  vacuo  at  its  maximum  density,  and  is 
equivalent  to  15.432  grains. 

The  unit  gram  (written  with  a  period  immediately  following,  thus, 
1.)  is  divided  or  multiplied  to  express  smaller  or  larger  denomina- 
tional quantities,  respectively,  by  simply  moving  the  decimal  point  to 


EQUIVALENTS   IN    THE    ENGLISH    WEIGHTS  AND   MEASURES.      243 

the  left  or  to  the  right.     This  illustrates  the  simplicity  of  the  entire 
system. 

To  designate  the  quantities  thus  obtained,  Latin  prefixes  are  used 
to  describe  those  less  than  one  gram,  and  Greek  those  larger  than  one 
gram — the  former  being  written  with  a  small  letter,  the  latter  with 
a  capital  letter. 

Metric  Weights. 

1  inyriagram  (Mg.)  =10,000      grams. 

1  kilogram  (Kg.)  =    1,000      grams. 

1  hectogram  (Hg.)  =       100      grams. 

1  decagram  (Dg-)  =         10      grams. 

1  gram  (Gm.)  =weight  of  1  c.c.  of  water  at  40  C.  (unit). 

1  decigram  (dg.)  =  0.1       gram. 

1  centigram  (eg.)  =  0.01    gram. 

1  milligram  (mg.)  =  0.001  gram. 

Metric  Measures  of  Capacity. 

1  myrialiter  (Ml.)  =10,000,000  cubic  centimeters. 

1  kiloliter  (Kl.)  =  1,000,000  cubic  centimeters. 

1  hectoliter  (HI.)  =  100,000  cubic  centimeters. 

1  decaliter  (Dl.)  =  10,000   cubic  centimeters. 

1  liter  (L.)  =  1,000  cubic  centimeters  (unit). 

1  deciliter  (dl.)  =  100  cubic  centimeters. 

1  centiliter  (cl.)  =  10  cubic  centimeters. 

1  milliliter  (ml.)  =  1  cubic  centimeter. 

Equivalents  in  the  English  Weights  and  Measures.— Various 
methods  have  been  proposed  for  adapting  the  metric  weights  to  our 
apothecaries'  weights  used  in  prescription-writing  without  entailing 
calculations  in  fractions,  as  the  exact  equivalent  would  necessarily  do. 
The  method  of  accepting  32  grams  as  equivalent  to  one  troy  ounce  and 
30  c.c.  as  equal  to  one  fluidounce  seems  to  be  the  least  objectionable. 

To  convert  avoirdupois  or  troy  into  metric  weights,  the  equivalent 
of  the  gram  in  grains — 15.432 — should  be  remembered,  as  it  serves  the 
purpose  of  a  basis  for  obtaining  the  equivalent  of  all  the  higher  denomi- 
nations. It  will  be  observed  that  this  number  is  composed  of  the  first 
five  numerals  in  reversed  order,  except  the  figure  1.  For  all  practical 
purposes  the  fraction  may  be  dropped,  and  1  gm.  may  be  said  to  equal 

15  gr. 

The, Liter  is  equivalent  to  34  fluidounces  (approximately  1  quart); 
half  a  Liter,  therefore,  approximating  1  pt.,  and  is  sometimes  called  a 
metric  pint  (17  fl.  oz.). 

The  Meter  is  equivalent  to  nearly  40  inches,  from  which  the  divi- 


244 


PERCENTAGE    IN    SOLUTIONS. 


sions  may  easily  be  rendered  as  follows:     i  decimeter,  4  in.;  1  centi- 
meter, cm.,  0.4  in.;  1  millimeter,  mm.,  0.04  (1/25)  inch. 

Hallberg  sums  up  the  advantages  of  the  metric  system  as  follows: 

1.  Simplicity  of  construction,  abolishing  complex  tables. 

2.  Uniformity,  through  its  adoption  in  all  scientific  work. 

3.  Permanency  and  stability  of  its  standard  unit  derived  from  the 
earth  itself. 

4.  Facility  of  its  multiplication  and  division  by  decimal  points. 

5.  Commensurability    of    all    its    units,  and    denominations    in 
weight,  volume,  linear  measures,  and  our  system  of  money. 

Equivalents  of  Apothecaries'  in  Metric  Weights. 


Grain. 

Gram. 

Grain 

Gram. 

1/200 

= 

.000324 

1/2 

= 

.0324 

1/150 

= 

.00043 

1 

= 

.0648 

1/100 

= 

. 00064 

2 

= 

.1296 

i/75 

= 

. 00086 

5 

= 

.3240 

1/50 

= 

.00129 

8 

= 

.5184 

1/40 

= 

.00162 

10 

= 

.6480 

1/20 

= 

.00324 

15 

= 

.9720  (approx.  1.0  gm.). 

1/10 

= 

. 00648 

20 

= 

1 .2960 

1/6 

= 

.0108 

3° 

= 

1.9440  (approx.  2.0  gm.), 

1/4 

= 

.0162 

40 

= 

2.5920 

1/3 

= 

.0216 

60 

= 

3.888  (approx.  4.0  gm.). 

Equivalents  of 

Apothecaries' 

in 

Metric  Measures  of  Capacity. 

Minims 

Cubic  centimeters. 

Fluidounces. 

Cubic  centimeters. 

1 

= 

0.061 

1 

= 

29-57 

2 

= 

0.123 

2 

= 

59-14 

3 

= 

0.185 

3 

= 

89.00 

5 

= 

0.308 

4 

= 

118.29 

7 

= 

Q.431 

6 

= 

177.42 

10 

= 

0.616 

10 

= 

295-73 

15 

= 

0.924 

(approx.  1 . 

0  c.c 

0 

12 

= 

355 -°° 

20 

= 

1.23 

16 

= 

473- 

17  (approx.  1/2  L.) 

30 

= 

1 .  84  (approx.  2 , 

0  c.c 

•) 

20 

= 

591-5° 

40 

= 

2.46 

24 

'  = 

710.00 

60 

= 

3-7 

(approx.  4 

.0  c.c 

:■) 

32 

= 

946. 

35  (approx.  1  L.) 

PERCENTAGE  IN  SOLUTIONS. 

To  estimate  the  quantity  of  a  drug  required  to  make  a  certain 
volume  of  a  solution  of  a  given  percentage,  multiply  the  weight  of  the 
volume  of  the  liquid  to  be  used  as  the  solvent  by  the  percentage.  Thus, 
in  an  ounce  of  a  10  per  cent,  aqueous  solution  of  silver  nitrate  there  are 
45.6  grains  of  the  salt. 


PERCENTAGE    IN    SOLUTIONS.  245 

100%  =   456.37  gr.  (weight  of  a  fl.  oz.  of  water). 
1%=    i/iooof  456.37,  or  4.56  gr. 
10%  =   10     4.56,  or  45.6  gr. 

Therefore,  it  is  well  to  remember  that  4.56  gr.  or,  approximately, 
4.5  gr.  of  any  drug  added  to  a  Ouidounce  of  water  makes  a  1  per  cent, 
solution  of  the  drug.  The  amount  of  a  drug  necessary  for  any  quantity 
of  any  per  cent,  solution  may  be  ascertained  by  multiplying  the  quantity 
by  the  percentage  by  4.5.  Thus,  to  ascertain  the  amount  of  cocain 
hydrochlorid  required  to  make  two  ounces  of  a  1.5  per  cent,  solution, 
we  would  multiply  2X1.5X4.5  =  13.5  gr-  Where  there  is  a  fraction  of 
a  grain  in  the  ultimate  result  it  is  best  to  drop  it  if  less  than  one-half,  or 
raise  it  to  one  if  over  one-half. 

To  determine  the  weight  of  a  fluidounce  of  a  liquid  other  than 
water,  multiply  456.37  by  the  specific  gravity  of  the  liquid,  and  the 
product  will  be  the  weight  desired. 


PRESCRIPTION- WRITIN  G. 

The  literal  interpretation  of  the  word  prescription  is  a  written 
order  for  something — from  prce,  for,  and  scribo,  I  write.  The  popular 
use  of  the  term,  however,  relates  to  medicines,  usually  meaning  a 
written  order  for  medicines,  although  it  is  frequently  employed  to 
designate  the  remedy  or  mixture  itself. 

The  art  of  prescription- writing  is  one  that  requires  practice  for  its 
perfection,  as  well  as  a  broad  knowledge  of  drugs,  their  actions  and 
their  doses,  and  their  indications  for  certain  diseases.  It  is  also  es- 
sential to  know  the  physical  and  chemic  properties  of  drugs  as  re- 
lated to  form  of  administration  and  possible  combination  with  other 
substances.  Through  the  development  of  the  sciences  of  pathology 
and  pharmacology  we  have  learned  that  it  is  unnecessary  to  exhaust 
our  materia  medica  in  prescribing  for  any  one  disease,  and  with  this 
more  definite  knowledge  of  the  action  and  effects  of  drugs  upon  the 
diseased  tissues,  organs,  and  functions  of  the  body,  we  find  that  only 
a  few  agents  can  be  employed  with  actual  benefit  in  our  endeavor  to 
assist  Nature  in  her  efforts  to  restore  an  abnormal  to  a  normal  condi- 
tion. To-day  simplicity  of  prescriptions  is  evidence  of  a  broad  knowl- 
edge of  the  conditions  to  be  met  by  the  application  of  drugs  or 
remedies  to  the  treatment  of  disease.  In  former  days  many  drugs 
were  combined  in  one  prescription,  and  the  remedy  given  with  the 
hope  and  expectancy  that  at  least  one  ingredient  might,  perchance, 
hit  the  spot.  To  such  formulas  the  term  "shot-gun"  prescriptions  is 
now  applied. 

The  most  important  considerations  in  writing  prescriptions  as  well 
as  in  reading  them  are: 

i.  The  language  and  abbreviations. 
2.  The  signs  and  terms. 

The  language  of  prescription-writing  is  primarily  Latin,  because 
pharmacopeial  titles  are  chiefly  used  in  designating  remedies.  Medi- 
cal Latin  will  be  referred  to  later.  Abbreviations  in  prescription- 
writing  is  perfectly  proper,  providing  they  are  not  carried  so  far  as  to 
cause  confusion  in  compounding  the  prescription.  The  signs  and 
terms  used  will  be  considered  conjointly  with  the  analysis  of  a 
prescription. 

246 


I'KKSCRIPTION-WRITING.  247 

A  prescription  may  be  divided  into  five  parts,  as  follows: 

1.  The  superscription,  or  heading. 

2.  The  inscription,  or  names  and  quantities  of  ingredients. 

3.  The  subscription,  or  directions  to  the  compounder. 

4.  The  signa,  or  directions  to  the  patient. 

5.  The  name  of  the  prcscriber,  his  degree,  and  the  date. 

The  superscription,  or  heading,  consists  of  the  abbreviation  }\,  for 
the  imperative  of  the  verb  recipio — recipe,  with  a  terminal  stroke  on  the 
R,  forming  the  sign  of  Jupiter,  x,  which  survives  as  a  relic  of  ancient 
times  when  all  medical  formuke  were  preceded  by  this  sign  as  an  in- 
vocation to  Jupiter,  the  chief  God.  Literally  translated  "take  thou" 
or  "take,"  it  tells  the  pharmacist  to  compound  the  ingredients  which 
follow.  The  name  of  the  patient  is  generally  though  not  necessarily 
included  in  this  part.  A  perfect  prescription  should  always  bear  the 
name  of  the  person  for  whom  the  medicine  is  intended,  and  if  for  a 
child  it  should  be  so  designated. 

The  inscription,  containing  as  it  does  the  names  and  quantities  of 
the  ingredients,  is  the  most  important  part  of  the  prescription,  and 
the  ingredients  are  invaribly  written  in  Latin  with  the  genitive  ending, 
the  quantities  following  on  each  line,  indicated  by  the  customary 
abbreviation.  Thus:  gr.  for  granum,  plural  grana — grain  or  grains; 
0  for  dram  (drachma) ;  §  for  ounce  (uncia) ;  and  O  for  pint  (octarius). 
The  abbreviations  lb  for  pound  (libra)  and  Cong,  or  C.  for  gal- 
lon (congius)  are  rarely  employed,  rr^  stands  for  minim  (mini- 
mum) ;  and  the  fluidrams  and  ounces  are  indicated  by  the  prefex  f , 
thus  f  5j,  f  oj-  Semissis,  abbreviated  ss,  is  used  to  indicate  a  half.  A 
prescription  written  with  the  troy  system  of  weights  always  contains 
Roman  numerals:  gr.  iv,  gr.  xx,  etc.;  when  written  with  the  metric 
weights  and  measures  they  are  expressed  in  decimals  in  Arabic  numer- 
als, preceded  by  gm.  or  c.c,  signifying  weight  or  measure:  gm. 
5.65,  c.c.  30.0. 

Signs  for  designating  the  measure  or  weight  of  the  mixture  are  some- 
times affixed  to  the  last  ingredient.     The  most  commonly  used  are: 

Ad,  the  preposition  "to";  ad  foiij"=-'  to  (measure)  three  fluid- 
ounces.  Quantum  sufjiciat,  abbreviated  q.  s. — as  much  as  is  suffi- 
cient. Of  these  signs  q.  s.  is  preferable,  since  ad  may  be  confused 
with  the  abbreviation  of  the  verb  adde,  meaning  to  add.  Ana,  ab- 
breviated eld,  meaning  of  each,  is  appended  when  the  same  quantities 
are  required  of  two  or  more  ingredients;  it  follows  the  last  of  these, 
just  preceding  the  quantity. 


248  PRESCRIPTION-WRITING. 

While  it  is  the  rule  that  every  word  in  the  inscription  must  ter- 
minate in  the  genitive  or  accusative  (the  names  of  the  ingredients  in 
the  genitive,  the  quantities  in  the  accusative),  they  are  rarely  written 
out  in  full,  but  nearly  always  abbreviated.  Where  the  first,  or  the 
first  and  second,  syllables  of  words  are  the  same,  e.  g.,  hydrargyrum 
and  hydrastis,  the  abbreviation  must  not  be  carried  so  far  as  to  in- 
volve doubt  as  to  which  drug  is  really  meant.  To  further  illustrate, 
the  drugs  just  mentioned  are  often  abbreviated  hydr.,  which  may 
mean  either  of  them,  or  when  followed  with  chlor.,  would  doubtless 
mean  hydrated  chloral,  but  might  also  be  mistaken  for  hydrargy- 
rum chloridum;  both  calomel  and  mercuric  chlorid  being  sometimes 
erroneously,  though  not  infrequently,  so  written.  The  author's  experi- 
ence behind  the  prescription-counter  leads  him  to  emphasize  the 
importance  of  correctly  writing  the  inscription. 

The  complete  inscription  is  made  up  of  the  basis,  or  active  con- 
stituent; the  adjuvant,  or  aid  to  the  basis;  the  corrective,  or  agent  to 
counteract,  modify,  or  correct  some  unpleasant  property  of  the  basis; 
and  forming  substance.  The  forming  substance  is  variously  termed 
according  to  the  form  or  consistence  of  the  mixture.  For  liquids  and 
ointments  it  is  called  vehicle;  for  powders,  diluent;  and  when  in  a  mass, 
as  in  pills  or  troches,  excipient.  This  is  according  to  the  maxim  of 
Asklepiades,  which  reads  curare  (basis),  cito  (adjuvant),  tuto  (correc- 
tive) et  jucunde  (vehicle,  diluent,  or  excipient),  to  cure  quickly,  safely, 
and  pleasantly.  Most  prescriptions  do  not  contain  all  of  these  ingre- 
dients; many  call  for  but  one. 

The  subscription  consists  of  certain  signs  and  terms  conveying 
directions  as  to  the  compounding  and  dispensing.  Generally  it  is 
better  to  leave  the  detail  of  compounding  to  the  pharmacist  who  is 
trained  in  the  art  of  pharmacy;  therefore,  the  abbreviation,  M,  which 
stands  for  the  Latin  imperative  of  the  verb  misce,  meaning  mix,  is 
usually  all  that  is  necessary.  This  sign  may  follow  a  dash,  thus  — M., 
just  to  the  right  of  the  last  ingredient  in  the  inscription,  or  it  may  be 
placed  to  the  left  under  the  sign  of  the  superscription.  When  special 
directions  are  necessary,  as  in  directing  the  number  of  powder,  capsules, 
or  pills,  into  which  the  mixture  is  to  be  divided,  they  may  be  written 
in  either  Latin  or  English — the  former  is  preferable,  providing  they 
are  correctly  written. 

Special  directions  abbreviated  are: 

M.  ft.  pulv.  chart,  div.  (No. — ),  mix  and  make  a  powder, 
divide  in  papers  (No. — ).  M.  ft.  cap.  (No. — ),  mix  and  make 
capsules  (No. — ).  M.  ft.  mass.  pil.  div.  (No. — ),  mix  and  make 
a  mass,  divide  in  pills  (No. — ). 


PRESCRIPTION-WRITING.  249 

The  Signa,  abbreviated  Sig.  or  S.,  includes  the  directions  to  be 
written  on  the  label  and  affixed  to  the  package  or  container.  These 
should  be  written  in  English  in  a  plain,  bold  hand- writing.  Sometimes 
it  is  better  for  the  patient  not  to  know  what  drug  is  taken,  for  this 
reason  the  inscription  and  subscription  are  written  in  Latin,  but  no 
secrecy  is  necessary  here;  in  fact,  to  write  the  directions  in  plain  English 
and  to  read  them  to  the  patient  or  attendant  may  serve  as  a  check 
on  any  possible  error  in  copying  the  directions  on  the  label.  The 
stereotyped  expression,  "Use  as  directed,"  should  be  avoided  as  far 
as  possible,  especially  where  the  prescription  is  intended  for  internal 
administration.  Many  serious  consequences  might  have  been 
averted  if  specific  directions  were  given. 

The  name  of  the  subscriber,  his  degree,  and  the  date  are  added  below 
the  signa.  Generally  it  is  not  in  good  taste  to  flourish  the  degree 
after  one's  signature  every  time  it  is  written ;  but  in  the  case  of  a  prescrip- 
tion it  is  essential  for  authenticity.  The  pharmacist  desires  to  know 
whether  the  prescriber  has  the  right  to  prescribe,  and  this  can  only  be 
known  by  the  degree.  When  prescription  blanks  are  used,  having  the 
preserver's  name,  degree,  and  address  printed  above  or  below  the 
space  reserved  for  the  prescription  proper,  all  that  is  necessary  is  to 
write  the  initals  and  the  date.     The  date  is  valuable  for  reference. 

It  may  be  questioned  by  some  whether  dentists  have  the  right  to 
prescribe  internal  remedies.  A  large  part  of  the  work  of  the  dentist 
is  to  treat  the  diseases  of  the  mouth  and  adjacent  tissues,  thus  allevi- 
ating human  suffering,  and  surely  he  has  the  right  to  use  any  drug  which 
he  knows  from  his  experience  will  aid  Nature  in  overcoming  the  patho- 
logic condition.  The  author  entered  upon  the  practice  of  dentistry 
through  the  gateway  of  pharmacy,  and  it  has  been  his  experience,  both 
as  a  pharmacist  and  as  a  dentist,  that  the  right  to  prescribe  will  never 
be  questioned  if  intelligence  is  shown  in  the  writing  of  the  prescription. 

The  order  usually  adopted  in  prescription-writing  is  as  follows: 
First,  after  the  fy  the  names  of  the  ingredients  are  written,  in  the  order 
of  their  importance;  then  the  number  of  doses  is  decided  upon,  the  in- 
dividual dose  of  each  drug  multiplied  by  the  number  of  doses,  gives  the 
quantities  to  be  affixed  to  the  names  of  the  ingredients.  In  selecting 
the  proper  quantity  for  liquid  mixtures,  the  regular  sizes  of  vials  alone 
are  considered.  These  are  i,  2,  and  4  dram,  and  1,  2  3,  4,  6,  8,  and 
16  ounce  capacity,  and  it  should  be  remembered  that  in  all  cases  a 
bottle  should  be  filled.  A  partially  filled  bottle  immediately  arouses 
suspicion  on  the  part  of  the  patient  as  to  the  possibility  of  mistake 
in  compounding  the  prescription. 


MEDICAL  LATIN. 

The  language  used  in  prescription-writing  is  primarily  Latin, 
because  pharmacopeial  titles  are  chiefly  employed  in  designating 
remedies.  It  is  never  necessary  to  tell  the  patient  what  drug  is  being 
used,  and  frequently  it  is  far  better  that  they  do  not  know,  because  of 
certain  idiosyncrasies,  prejudices,  and  other  reasons.  Therefore, 
it  is  better  to  always  write  the  inscription  and  sometimes  the 
subscription  of  a  prescription  in  Latin.  The  rule  is  to  have 
the  name  of  every  ingredient  end  in  the  genitive  and  the  quan- 
tities in  the  accusative.  It  is  true  that  much  ignorance  of  the 
Latin  language  can  be  covered  up  in  prescription-writing  by  using 
abbreviations,  and  while  it  is  also  true  that  to  abbreviate  is  perfectly 
proper,  providing  it  is  not  carried  so  far  as  to  involve  doubt  as  to  what 
drug  is  wanted;  nevertheless,  a  working  knowledge  at  least  of  this  dead 
language  will  be  of  inestimable  value.  Therefore,  a  few  rules  of  Latin 
grammar  applicable  to  prescription- writing  are  here  given:  The 
quantities  of  the  ingredients  appear  in  the  accusative  case,  governed  by 
the  imperative  of  the  verb  "Recipe";  the  quantities,  however,  are  seldom 
written  out  in  full.  The  names  of  the  ingredients  appear  in  the  genitive 
case,  the  construction  reading  "Recipe  drachmamunamphenolis,"  take 
one  dram  of  phenol,  1^  phenolis,  5  j.  The  directions  to  the  pharmacist 
are  very  simple,  unless  special  directions  are  necessary:  M.  for  "misce," 
is  generally  all  that  is  required.  The  directions  to  the  patient 
should  always  be  written  in  English.  All  nouns  ending  in  a  in  the 
nominative,  end  in  a  in  the  genitive,  and  are  of  the  first  declension; 
the  accusative  ends  in  am  and  the  nominative  plural  in  ce;  there  are  a 
few  exceptions  of  Greek  derivation,  such  as  enema,  gramma,  theobroma, 
— the  genitive  ending  for  these  is  atis.  Nouns  terminating  in  us  in  the 
nominative,  end  in  i  in  the  genitive,  and  are  of  the  second  declension, 
um  for  the  accusative  singular,  and  i  for  the  nominative  plural;  there 
are  a  few  exceptions  to  this  rule  with  nouns  of  the  fourth  declension, 
as  fructus  and  spiritus  (these  do  not  change  in  the  genitive).  The 
nouns  ending  in  um  in  the  nominative  singular  are  neuter  in  gender 
and  of  the  second  declension;  they  change  to  i  in  the  genitive,  um  in 
the  accusative,  and  a  in  the  nominative  plural.  All  other  pharma- 
copeial nouns  belong  to  the  third  declension  and  change  variously  in 

250 


MEDICAL   LATIN.  25 1 

the  different  cases,  and  for  the  most  part  must  be  studied  individually. 
For  example:  as  becomes  at  is;  is  may  remain  is  or  change  to  iiiis,  ids, 
or  eris  in  the  genitive;  the  accusative  of  as  becomes  am,  the  nominative 
plural  atea.  Some  nouns  do  not  change  at  all,  e.g.,  sassafras.  Adjec- 
tives agree  with  their  nouns  in  number,  gender,  and  case;  those  ending 
in  us,  terminate  with  a  for  the  feminine  and  urn  in  the  neuter  gender, 
and  are  declined  according  to  the  first  and  second  declensions.  Adjec- 
tives ending  in  is  and  ens  are  declined  according  to  the  third  declension; 
the  first  ends  in  e  in  the  neuter  gender.  A  few  nouns  of  Greek  origin 
end  in  e,  and  form  a  genitive  of  es,  and  an  accusative  of  en;  aloe,  aloes, 
is  an  example. 

When  special  directions  are  necessary  for  the  dispensing  of 
powders,  capsules,  and  pills,  they  may  be  given  as  follows:  Fiat  piilvis  et 
divide  in  chartulas  No.  x. — make  a  powder  and  divide  into  10  papers. 
Dispensa  in  capsulis  No.  xij — dispense  in  12  capsules.  Fiant  pilulce 
No.  xx — make  20  pills. 

An  official  for  inula  may  be  specified  in  a  prescription  as  follows: 
1$  Pulveris  opii  et  ipecacuanha?,  gr.  xx.  Fiat  chartulas  Xo.  iv. 
Sig.  — Take  one  or  two  powders  on  retiring  and  keep  well  covered.  In 
this  prescription  the  nominative  pulvw  changes  to  pulveris  in  the 
genitive;  opium  changes  to  opii;  and  ipecacuanha  changes  to  ipecacuan- 
ha. Thus  the  value  of  the  above  rules  of  Latin  grammar  is  seen.  To 
abbreviate  the  names  of  the  ingredients  in  the  above,  we  could  use 
pulv.  for  pulveris,  ipecac,  for  ipecacuanhas,  but  we  could  not  intelli- 
gently abbreviate  opii — it  would  be  necessary  to  write  in  full  in  the  Latin 
nominative  or  the  English  (which  is  the  same  in  this  instance — opium). 
To  write  it  in  the  Latin  nominative  in  the  inscription  is  wrong,  and  to 
write  it  in  English  with  the  other  words  abbreviated  in  Latin  is  also 
wrong.  So  while  much  ignorance  of  the  Latin  language  may  be 
covered  up  by  abbreviation  in  prescription- writing,  occasionally  this 
lack  of  knowledge  will  manifest  itself;  therefore  it  is  the  wiser  plan  to 
become  familiar  with  these  simple  rules.  As  has  been  elsewhere 
stated,  the  art  of  prescription-writing  is  one  that  requires  a  great  deal 
of  practice  for  its  perfection. 

In  conclusion  the  author  desires  to  state  that  if  any  part  of  the 
inscription  or  subscription  cannot  be  properly  written  in  Latin,  by 
all  means  write  the  entire  prescription  in  English.  This  is  by  no 
means  meant  to  discourage  the  use  of  Latin  in  prescription-writing.1 

'Those  desiring  to  study  this  subject  further  will  find  St.  Clair's   "Medical  Latin" 
a  valuable  book. 


252  PRACTICAL  PRESCRIPTIONS. 

EXAMPLES  OF  PRACTICAL  PRESCRIPTIONS. 

Powders. 

For    Mrs. . 

R — Pulveris  Acetanilidi  Compositae,     gr.  xv  (1.0  gm.). 
Fiat  chartulas  No.  ij. 
Sig. — Take  one  (1)  powder  at  once  and  the  other  in  two  (2)  hours, 
if  not  relieved. 
(Date)  ,  D.D.  S. 

For  Baby  . 


R — Hydrargyri  chloridi  mitis,  gr.  j  (0.06  gm.) 

Sodii  bicarbonatis,                           gr.  xx  (1.3  gm.) — M. 
Fiat  chartulas  No.  x. 
Sig. — Take  one  (1)  powder  every  hour  until  three  (3)  or  four  (4) 
are  taken. 
(Date)  ,  D.  D.  S. 

For  Mr. . 

R — Acetphenetidini, 

Salophen,  aa     gr.  x  (0.6  gm.) 

Codeinae  Sulphatis,  gr.  j  (0.06  gm.)— M. 

Fiat  chartulas  No.  iv. 
Sig. — Take  one  (1)  powder  every  three  (3)  hours. 

(Date)  ,  D.D.S. 

Tooth  Powders. 

No.  1. 
For  General  Use. 
1} — Calcii  carbonatis  ppt.,  oxiv  (448.0  gm.) 

Saponis  pulveris  (U.  S.  P.), 
Sacchari  pulveris,  aa     §ij  (64.0  gm.) 

Sodii  benzoatis,  §ss  (16.0  gm.) 

Eucalyptolis,  rr(X  (0.6  c.c.) 

Thymolis,  gr.  x  (0.6  gm.) 

Cinnaldehydi,  tt^xv  (i.o  c.c.) — M. 

Fiat  pulvis. 
Sig. — Use  as  a  general  tooth-powder. 

(Date)  ,  D.  D.  S. 

No.  2. 

For  General  Use. 

R- — Calcii  carbonatis  ppt.,  5xx  (640.0  gm.) 

Orris  radices  pulv.,  §iv  (128.0  gm.) 

Saponis  pulv.  (U.  S.  P.),  oij  (64.0  gm.) 
Sacchari, 

Sodii  boratis,  aa.     5j  (32.0  gm.) 

Thymolis,  gr.  xv  (1.0  gm.) 


PRACTICAL   PRESCRIPTIONS.  253 

Eucalyptolis,  r^x  (0.6  gm.) 

Olei  gaultheriae, 

Olei  menthae  piperita?,  aa.     n\xx  (1 .3  gm.)— M. 

Fiat  Pulvis. 
Sig. — Use  as  a  general  tooth-powder. 

(Date)  ,  D.  D.  S 

Capsules. 

For  Mr. . 


]}— Quininse  bisulphatis,  gr.  xxiv  (1.5  gm.) 

Dispensa  in  capsulis  No.  viij. 
Sig. — Take  one  (1)  capsule  before  meals  and  on  retiring. 

(Date)  ,  D.  D. 

Pills. 

For  Mrs. . 


T^— Quininae  valerianatis,  gr.  xviij  (1.2  gm.) 

Extracti  hyoscyami,  gr.       iv  (0.26  gm.) 

Extracti  cinchonae,  gr.  viij  (0.5  gm.)— M. 

Fiat  massa  et  divide  in  pilulse  No.  xij. 
Sig.— Take  one  (1)  pill  before  meals  and  on  retiring. 

(Date)  ,  D.  D.  S. 

(Cosmos.) 


Solutions  (Dobell's  Solution). 

For  Mr. . 

B — Sodii  bicarbonatis, 

Sodii  boratis,  aa   ojU-ogm.) 

Phenolis  (ays.),  oss  (2.0  gm.) 

Glycerini,  f5j  (30.0  c.c.) 

Aquae,  Oij  (1.0  L.)— M. 

Sig. — Use  as  a  spray,  mouth-wash,  or  gargle. 

(Date)  ,  D.  D.  S. 

(Antiseptic  Solution  U.  S.  P.) 

For  Mrs.  . 

I}—  Liquoris  Antiseptici,                            fo viij  (240.0  c.c.) 
Sig. — Dilute  with  one-half  warm  water  and  use  as  a  mouth-wash. 
(Date)  ,  D.  D.  S. 

For  Miss . 


3— Antipyrini,  '   oss  (2.0  gm.) 

Sodii  bromidi,  5j  (4-0  gm.) 

Glycerini,  f5ij  (8.0  c.c.) 

Aquae  cinnamomi,  q.  s.  ad.     f5j  (30.0  c.c.) — M 

Sig. — Take  a  teaspoonful  three  times  a  day,  after  meals. 

(Date)  ,  D.  D.  S. 


254 


PRACTICAL    PRESCRIPTIONS. 


For  Mrs. 


fy— Potassii  iodidi,  ojss  (6.0  gm.) 

Syrupi  sarsaparillae  comp.,             foiij  (9°-°  c-c-) — M. 
Sig. — Take  a  teaspoonful  in  water  three  times  a  day,  after  meals. 
(Date)  ,  D.  D.  S. 


For  Mr. . 

~fy— Acetanilidi,  gr.  viij  (0.5  gm.) 

Syrupi  simplex,  foss  (15.0  c.c.) 

Spiritus  frumenti,  q.  s.  ad.  f5iij  (90.0  c.c.)— M. 
Sig. — Take  one-half  at  once  and  the  remainder  in  two  (2)  hours,  if 
not  relieved. 

(Date)  ,  D.  D.  S. 

Collyrium  (Eye-water). 
For  Mr. 


I$— Sodii  boratis,  gr.  x  (o .  6  gm.) 

Acidi  borici,  sat.  sol.,                      foj  (300  c.c.)— M. 
Sig. — Warm  to  body  temperature  and  drop  into  the  eye  with  a  drop 
applicator. 
(Date)  ,  D.  D.  S. 

Gargle  (Mercurial  Stomatitis  or  Sore  Throat). 

For  Miss . 

I}—  Potassii  chloratis,                             ojss  (6.0  gm.) 
Tincturae  myrrhae,                            f3ij  (8.0  c.c.) 
Alcoholis,                                          foss  (15.0  c.c.) 
Aquas  cinnamomi,                            fovi  (180.0  c.c.)— M. 
Sig.— Thoroughly  gargle  the  throat  three  times  daily.     If  too 
strong,  dilute  with  warm  water. 
(Date)  ,  D.  D.  S. 

Liniments. 

For  Dentists'  Use. 
I$— Mentholis, 

Iodi  (crys.),  aa.     gr.  x  (0.6  gm.) 

Chloroformi,  f  o  jss  (6 .  o  c.c.) 

Tincturae  Aconiti,  q.  s.  ad.     foj  (30.0  c.c.)— M. 

Sig. — Use  as  a  refrigerant  counterirritant. 

(Date)  ,  D.  D.  S. 

For  Dentists'   Use. 
It— Mentholis,                                        gr.  xx  (1.3  gm.) 
Chloroformi,                                     fojss  (6.0  c.c.j 
Tincturae  aconiti,           q.  s.  ad.     foj  (30.0  c.c.)— M. 
Sig. — Apply  freely  to  gums  in  cases  of  nonseptic  pericementitis. 
(Date)  ,  D.  D.  S. 


PRACTICAL   PRESCRIPTIONS.  255 


For  Mr. . 

1$ — Camphorae  (gum),  5 i j  (8.0  gm.) 

Tincturae  aconiti,  f3j  (30.0  c.c.) 

Linimenti  saponis,         q.  s.  ad.     f5iij  (90.0  c.c.) — M. 
Sig. — Applv  locallv  with  massage  in  cases  of  neuralgia. 

(Date)  ,  D.  D    S 


INCOMPATIBILITY  IN  PRESCRIPTIONS. 

When  two  or  more  different  substances  are  brought  together  in  a 
mixture,  be  it  liquid  or  solid,  with  the  result  of  undergoing  a  more  or 
less  complete  change,  not  intended,  they  are  said  to  be  incompatible. 

Incompatibility,  so  far  as  it  applies  to  the  combination  (not  the 
action)  of  drugs,  may  be  of  two  kinds — physical  and  chemic.  The 
only  truly  scientific  method  of  determining  the  incompatibility,  or  the 
contrary,  of  the  ingredients  of  a  mixture  is  a  correct  knowledge  of 
physical  and  chemic  laws  and  their  practical  application  in  phar- 
macy and  therapeutics. 

Physical  incompatibility  is  largely  a  question  of  the  solubility  of 
drugs.  It  results  when  precipitates  are  formed  without  the  precipi- 
tated substance  losing  its  former  identity;  i.  e.,  without  chemic 
change.  It  also  occurs  when  an  effort  is  made  to  mix  nonmiscible 
substances,  as  oil  and  water. 

Gums  and  other  mucilaginous  substances  are  soluble  in  water,  but 
insoluble  in  alcohol.  Therefore,  the  addition  of  alcohol  to  an  aqueous 
solution  of  a  gum  results  in  the  precipitation  of  the  gum  without 
chemic  change. 

Example:  Mucilage  of  tragacanth  with  any  alcoholic  tincture 
(tincture  of  aconite)  will  precipitate  the  tragacanth. 

Resinous  substances  are  soluble  in  alcohol,  but  insoluble  in  water. 
The  addition  of  water,  therefore,  to  an  alcoholic  solution  of  a  resin 
results  in  the  physical  precipitation  of  the  resin. 

Example:  Water  added  to  tincture  of  podophyllum  will  precipitate 
the  resinous  active  constituent,  podophyllin. 

Any  mouth-wash  or  solution  containing  a  considerable  amount  of 
the  essential  oils,  held  in  solution  by  alcohol,  will  become  turbid  upon 
the  addition  of  water,  due  to  the  physical  incompatibility  of  the  oil 
and  water. 

Chemic  incompatibility  involves  a  chemic  change  when  sub- 
stances are  mixed,  whereby  their  former  identity  is  lost.  To  be  able  to 
predict  chemic  incompatibility  requires  a  knowledge  of  chemic  laws 
and  their  practical  application.  It  is  well  to  remember  a  few  of  the 
more  common  of  these  laws.     For  example: 

i.  It  is  a  principle  in  chemistry  that  when  solutions  of  soluble 
salts  are  brought  together  there  is  generally  an  exchange  of  radicals 

256 


I\|'UMI'\  I  Il'.il  I  I  \     I\     I'KKSCRIPTIONS.  257 

with  the  formation  of  a  precipitate,  ii  either  of  the  newly  formed  salts 
is  insoluble.  To  illustrate:  When  solutions  of  silver  nitrate  and 
sodium  chlorid  are  brought  together  a  white  precipitate  of  silver 
chlorid  is  formed.  Here  there  is  an  exchange  of  radicals,  and  the 
silver  chlorid,  being  insoluble  in  the  water,  is  precipitated,  while  the 
sodium  nitrate;  being  soluble,  dissolves  as  soon  as  it  is  formed.  Ad- 
vantage is  taken  of  chemic  incompatibility  when  silver  rvitrate  is  used 
about  the  mouth;  any  excess  can  be  neutralized  at  once  by  having  the 
patient  rinse  the  mouth  with  a  solution  of  common  salt. 

2.  Strong  mineral  acids  decompose  salts  of  the  weaker  mineral  or 
vegetable  acids,  and  also  form  ethers  with  alcoholic  preparations.  To 
illustrate:  Sodium  bicarbonate  is  chemically  incompatible  with  hydro- 
chloric acid.  Here  the  chlorin  of  the  hydrochloric  acid  has  a  greater 
affinity  for  sodium  than  has  the  weaker  carbonic  radical,  hence  it  dis- 
places the  latter,  forming  sodium  chlorid  and  liberating  carbonic  acid, 
which  immediately  breaks  up  into  water  and  carbon  dioxid.  The 
carbon  dioxid  being  a  gas  causes  the  effervescence.  An  illustration 
of  the  formation  of  ethers  by  adding  a  strong  mineral  acid  to  alcoholic 
solutions  is  found  in  making  ether,  where  sulphuric  acid  is  added  to 
alcohol.  In  this  case,  of  course,  sulphuric  acid  and  alcohol  are  not 
considered  incompatible  because  ether  is  the  product  desired,  but  if 
it  were  not,  then  they  would  be  chemically  incompatible. 

As  a  matter  of  fact,  all  drugs  are  incompatible  with  their  chemic 
tests  or  antidotes,  a  knowledge  of  which  means  a  knowledge  of  the 
science  of  chemistry,  and  to  mention  all  would  be  inappropriate  in  a 
work  of  this  kind.     A  few  common  examples  are  here  given: 

Alkalies  and  alkaline  carbonates  are  incompatible  with  acid  solu- 
tions, acid  salts,  and  alkaloidal  salts.  Arsenic  trioxid  with  tannic  acid 
and  salts  of  iron.  Alkaloids  and  alkaloidal  salts  with  tannic  acid. 
Phenol  with  collodion.  Powerful  oxidizing  agents  with  easily  oxidizable 
substances,  causing  combustion,  and  even  explosion.  Oxidizing 
agents  are:  potassium  chlorate,  potassium  permanganate,  chromic, 
nitric,  and  nitrohydrochloric  acids.  Easily  oxidizable  agents  are: 
sugar,  glycerin,  alcohol,  fats,  sulphur,  carbon,  and  phosphorus. 

The  following  drugs,  so  far  as  possible,  had  better  be  prescribed 
alone: 

Strong  mineral  acids.  Potassium  Chlorate. 

Alkalies.  Potassium  Permanganate. 

Arsenic  Trioxid.  Silver  Nitrate. 

Iron  salts.  Tannic  Acid. 

Mercuric  Chlorid  (incompatible  with  almost  everything). 

!7 


258  ANTAGONISM    OF   DRUGS. 

ANTAGONISM  OF  DRUGS. 

As  has  been  observed  in  the  study  of  physiologic  action,  certain 
drugs  produce  opposite  effects.  This  is  known  as  antagonism  of  drugs, 
called  also  physiologic  or  therapeutic  incompatibility.  The  antagonistic 
effects  of  drugs  is  recognized  in  therapeutics  as  a  means  of  guarding 
against  drug  poisoning  or  in  the  treatment  of  poisoning  when  toxic 
symptoms  are  manifested.  In  this  connection  the  term  physiologic 
antidote  is  used. 

The  antagonistic  action  of  drugs,  however,  is  never  as  positive 
as  is  the  case  with  chemic  incompatibility,  for  there  are  few  drugs, 
indeed,  whose  action  is  directly  opposite,  and  whose  effects  will  neu- 
tralize completely  the  effects  of  other  drugs.  The  antagonism  of  drugs 
or  physiologic  antidotes  is  well  illustrated  in  the  treatment  of  cocain 
poisoning  (see  p.  123). 


PART  II. 

PRACTICAL  DENTAL  THERAPEUTICS. 

GENERAL    CONSIDERATIONS. 

Therapeutics  is  the  application  of  drugs  or  remedies  to  the  treat- 
ment of  disease.  Dental  therapeutics  differs  in  no  way  from  general 
therapeutics,  except  it  includes  only  the  treatment  of  diseases  of  the 
mouth  and  adjacent  structures  or  such  general  diseases  as  are  mani- 
fested in  the  mouth.  In  the  latter  instance  it  is  the  duty  of  the  dentist 
to  collaborate  with  the  family  physician  in  the  treatment  of  the  case. 

In  considering  the  practical  therapeutics  of  the  more  common 
diseases  which  the  dentist  is  called  upon  to  treat,  the  author  will  draw 
largely  upon  his  own  experience  gained  from  actual  practice  and  from 
extensive  reading  of  current  dental  and  medical  literature. 

It  should  be  understood  at  the  outset  that  there  are  three  essen- 
tial factors  upon  which  all  successful  therapeutics  rests.  First,  to  be 
able  to  recognize  a  pathologic  condition  and  make  a  correct  diagnosis. 
This  means  that  the  successful  therapeutists  must  possess  a  broad 
knowledge  of  general  pathology  and  a  special  knowledge  of  dental 
or  oral  pathology;  secondly,  to  know  what  drug,  or  remedy,  if  properly 
applied  or  administered,  will  reach  the  recognized  pathologic  condition 
and  act  the  most  favorably.  This  means  that  successful  therapy 
depends  upon  a  broad  knowledge  of  pharmacology — a  science  which 
treats  of  the  action  of  drugs  and  remedies  upon  the  tissues,  organs,  and 
functions  of  the  body;  and  thirdly,  to  have  at  hand,  in  a  convenient  and 
practical  form,  that  drug  or  remedy  which  experience  has  taught  will 
assist  Nature  in  her  efforts  to  restore  an  abnormal  to  a  normal 
condition. 

The  tendency  in  dental  as  well  as  in  general  therapeutics  to-day 
is  to  place  the  treatment  of  disease  upon  a  rational  basis.  The  pro- 
gressive dentist,  therefore,  is  no  longer  satisfied  to  know  that  results  may 
be  obtained  by  the  use  of  certain  remedies  in  the  treatment  of  certain 
diseases,  but  he  has  a  strong  desire  to  know  also  why  those  results  are 
brought  about.  In  the  following  pages  only  such  pathologic  data 
will  be  given  as  is  deemed  essential  incident  to  the  therapeutics  of  the 
condition  under  consideration,  but  every  effort  will  be  made  to  tell, 

259 


260  PRACTICAL   DENTAL   THERAPEUTICS. 

as  far  as  is  known,  why  the  remedies  suggested  are  indicated  and  what 
may  be  expected  from  their  judicious  employment.  This  means  that 
it  will  be  necessary  to  practically  discard  all  obsolete  or  untried  reme- 
dies. In  other  words,  only  such  remedies  will  be  considered  in  detail 
here  as  have  been  found  to  be  of  real  practical  value. 


DISEASES  OF  THE  HARD  TISSUES  OF  THE  MOUTH 
AXD  ASSOCIATED  STRUCTURES. 

HYPERSENSITIVE  DENTIN. 

GENERAL  CONSIDERATIONS. 

Authorities  differ  in  regard  to  the  sensitivity  of  dentin.  According 
to  Barrett,  dentin  in  the  normal  condition  should  be  without  sensation; 
the  source  of  sensitive  dentin,  or  of  impressionable  pulps,  lies  in  their 
continued  subjection  to  irritation  by  which  responsiveness  is  developed. 
Burchard-Inglis  states  that  all  vital  dentin  is  sensitive;  that  the  degree 
of  sensitivity  differs  markedly  in  individuals;  and  it  is  only  when 
hypersensitiveness  is  observed  that  the  condition  becomes  pathologic. 
It  might  also  be  mentioned  that  the  sensitivity  differs  in  the  same  in- 
dividual at  different  times.  Black  differentiates  between  hypersensi- 
tiveness and  thermal  sensitiveness  of  dentin,  claiming  that  the  sharp 
pain  caused  by  sudden  changes  of  temperature  is  normal,  though  no 
other  tissue  or  organ  of  the  body  shows  a  like  resistance  to  thermal 
changes.  Under  certain  conditions  hypersensitiveness  to  thermal 
changes  may  develop,  when  the  condition  becomes  pathologic.  Ther- 
mal sensitiveness  as  well  as  hypersensitiveness  of  dentin  is  often 
developed  during  the  progress  of  decay,  therefore,  in  the  preparation 
of  cavities  for  fillings  we  find  few  teeth  the  dentin  of  which  is  without 
sensation.  This  fact  is  not  surprising,  nor  can  it  be  construed  as 
being  contrary  to  the  statement  that  normal  dentin  is  not  sensitive  when 
we  remember  that  there  are  few  teeth  in  the  mouths  of  patients  de- 
manding the  services  of  the  dentist,  the  dentinal  fibillae  and  pulps  of 
which  have  not  been  subjected  to  continued  irritation. 

In  the  discussion  of  means  and  methods  by  which  the  sensitiveness 
of  the  dentin  can  be  allayed  I  shall  not  attempt  to  enter  into  the 
details  of  the  many  histologic  and  pathologic  phenomena  which  are 
certain  to  arise  in  the  consideration  of  the  therapeutics  of  this  subject, 
but  shall  confine  myself  largely  to  the  drug  aspect. 

The  sensitiveness  of  the  dentin  can  be  obtunded  in  no  small  degree 
by  the  use  of  various  therapeutic  agents;  and  I  might  state  that  there 
are  few  operations  which  we  are  called  upon  to  perform  wherein  the 
patient  will  appreciate  our  efforts  more  than  in  this  by  applying  drugs 

261 


262  PRACTICAL   DENTAL    THERAPEUTICS. 

and  remedies  for  the  mitigation  of  pain.  But  in  order  to  apply  in- 
telligently and  successfully  any  remedy,  whether  it  be  a  drug  or  an 
agent,  to  the  dentin  and  thereby  obtund  the  sensitivity  of  the  dentinal 
fibrillar  without  endangering  the  vitality  of  the  pulp  itself,  we  must 
be  familiar  with  several  factors  or  conditions,  which  I  cannot  with 
propriety  here  discuss,  in  detail  at  least.  For  instance,  a  thorough 
knowledge  of  the  anatomic  and  histologic  structure  of  the  tooth  is  of 
the  highest  importance,  as  is  also  a  knowledge  of  the  pathology, 
not  only  of  the  fibrillar,  but  of  the  pulp  tissue  as  well — the  changes 
which  these  structures  are  capable  of  undergoing  if  unduly  irritated 
by  the  application  of  the  remedy  employed.  Still  another  factor  of 
equal  importance,  and  one  which  more  directly  relates  to  the  phase  of 
the  subject  under  consideration,  is  a  knowledge  of  the  pharmacologic 
action  and  the  therapeutic  application  of  the  drugs  and  remedies  used 
for  this  purpose.  Before  using  a  drug  or  an  agent  for  allaying  the 
sensitiveness  of  dentin,  or  for  any  other  purpose,  we  should  know 
what  action  to  anticipate  from  its  employment  This  is  not  too  much 
to  expect  from  the  trained  dental  practitioner  of  to-day. 

THERAPEUTICS. 

The  remedies  suggested  for  obtunding  sensitive  dentin  have  been 
many  and  varied.  I  shall  discuss  only  those  which,  from  clinical 
experience,  have  proved  of  sufficient  value  to  merit  consideration; 
and  for  convenience  of  study,  will  divide  them  into  four  general  classes. 

I.  PHYSICAL  AGENTS. 

There  are  some  physical  agents  by  the  proper  use  of  which  the 
sensitiveness  of  dentin  can,  in  a  measure,  be  obtunded.  The  most 
common  are: 

Heat.  Light. 

Cold.  Electricity. 

Heat. — The  application  of  dry  heat  to  a  sensitive  cavity,  especially 
in  conjunction  with  a  dehydrating  agent,  such  as  absolute  alcohol, 
is  always  an  aid;  and  this  is  accomplished  by  means  of  heating  dry 
air,  and  gently  directing  a  current  of  air  thus  heated  into  the  cavity 
which  has  been  insolated  by  the  rubber  dam  and  moistened  with 
the  dehydrating  agent  used.  Care  must  be  taken  not  to  primarily 
cause  pain,  otherwise  the  object  of  using  the  agent  would  be  defeated. 


IIVI'KRSENSITIVE    DENTIN.  263 

Several  apparatuses  bave  been  devised  for  heating  the  air.  Dr. 
Rudolph  Beck  has  recently  perfected  a  convenient  electrical  device 
by  means  of  which  compressed  air  can  be  heated  as  it  passes  through. 
Other  such  devices  are  on  the  market.  In  the  absence  of  any  of  these, 
the  chip-blower  can  be  employed,  however,  with  less  satisfaction. 
Inasmuch  as  heat  is  used  in  conjunction  with  another  and  more  impor- 
tant class  of  remedies,  I  shall  refer  to  this  agent  later. 

Cold  is  another  physical  agent  sometimes  employed  for  the 
purpose  of  desensitizing  the  dentin.  Heat  may  be  abstracted  from  the 
tooth-structure  by  spraying  the  cavity  with  a  highly  volatile  liquid,  like 
ether,  rhigolene,  or  ethyl  chlorid.  In  the  use  of  these  agents,  advan- 
tage is  taken  of  the  physical  law  that  a  solid  in  changing  its  form  to  a 
liquid,  or  a  liquid  in  changing  its  form  to  a  vapor  or  gas,  must  abstract 
from  the  thing  to  which  it  is  applied,  a  certain  amount  of  heat  in  order 
to  effect  the  change.  Ether,  or  combinations  containing  ether,  and 
ethyl  chlorid,  both  used  as  sprays,  have  proved  valuable  in  some 
instances,  especially  shallow  cavities  near  the  gum  the  dentin  of  which 
is  difficult  to  obtund  by  the  usual  methods  employed,  and  to  which 
reference  will  be  made  later. 

A  precaution  to  be  taken  to  prevent  primary  pain  in  applying  this 
remedy  is  to  fill  the  cavity  temporarily  with  stopping  and  direct  the 
spray  first  on  this  and  surrounding  parts,  after  which  the  stopping  can 
be  removed  and  the  spray  directed  into  cavity  without  any  appreciable 
pain.  The  degree  of  refrigeration  must  not  be  carried  to  the  point  of 
having  a  possible  deleterious  effect  subsequently  upon  the  pulp  or  gum 
tissue. 

A  practical  method  of  combining  dryness  and  cold  as  a  means  of 
obtunding  sensitive  dentin  has  been  suggested  by  Dr.  W.  T.  Reeves. 
It  consists  in  directing  a  small  jet  of  compressed  air  directly  into  the 
cavity  a  few  moments  before  operating,  and  keeping  it  up  during  the 
drilling  process.  To  prevent  primary  pain,  cotton  saturated  with  an 
analgesic  and  antiseptic  remedy  may  be  placed  in  the  cavity  first. 
The  air  serves  a  threefold  purpose;  it  keeps  the  cavity  dry;  clears  the 
field  from  chips;  and,  what  is  important  here,  it  lessens  the  heat  of 
drilling  which  is  responsible  for  most  of  the  pain  in  cavity  preparation. 
Those  inexperienced  with  the  method  must  be  careful  at  first,  as  the 
absence  of  pain  and  the  clear  held  may  lead  one  to  think  that  the  bur  is 
not  cutting,  as  a  result  one  is  liable  to  drill  deeper  than  is  absolutely 
necessary. 

Light  has  recently  been  brought  forth  as  having  a  peculiarly 
favorable  effect  upon  hypersensitive  patients.     In  one  method  the  ray- 


264  PRACTICAL    DENTAL    THERAPEUTICS. 

of  light  are  colored  by  passing  through  a  blue  glass.  This  is  ac- 
complished by  darkening  the  room  and  employing  a  blue  bulb  (16  or 
32  c.  p.)  on  an  ordinary  electric  socket.  Whether  the  light  acts  locally 
or  affects  the  vision  and  thus  the  general  nervous  system,  has  yet  to  be 
demonstrated.  The  result  of  the  author's  experience  with  this  agent 
thus  far  has  not  been  encouraging. 

Electric  Current. — This  agent  has  been  employed  as  a  means 
of  carrying  certain  drugs  into  the  dentin  and  pulp  tissue  for  obtundent 
purposes.  The  method  is  called  cataphoresis;  but  because  of  the  ex- 
pensive and  complicated  apparatus,  the  length  of  time  required  to 
obtund  as  well  as  oftentimes  unsatisfactory,  and,  in  not  a  few  instances, 
disastrous  results,  the  method  has  generally  been  discarded. 


II.  ESCHAROTICS  OR  CAUSTICS. 

Any  drug  or  agent  which  will  cauterize  the  dentinal  fibrillar,  will 
obtund  sensitive  dentin.  There  are  many  drugs,  however,  belonging 
to  this  class  that  cannot  be  used  for  this  purpose  because  of  their 
deleterious  effect  upon  both  the  tooth  structure  and  the  pulp  tissue. 
For  instance,  the  strong  mineral  acids  will  disorganize  the  protoplasmic 
dentinal  fibrillar;  but  they  will  also  disintegrate  the  inorganic  structure 
of  the  tooth.  Arsenic  trioxid  has  a  specific  poisonous  action  upon  the 
nbrillae,  but  there  is  no  known  means  of  preventing  the  same  deleterious 
effect  upon  the  cells  of  the  pulp  tissue. 

The  most  valuable  escharotics  for  desensitizing  the  dentin  are: 

Phenol.  Trichloracetic  Acid. 

Zinc  Chlorid.  Silver  Nitrate. 

It  must  be  noted  that,  while  these  agents  will  obtund,  the  ultimate 
result  is  too  often  produced,  with  the  possible  exception  of  phenol, 
at  the  expense  of  quite  as  much  suffering  as  they  save. 

Phenol  has  local  analgesic  properties  besides  that  of  cauterant, 
and  will,  therefore,  be  discussed  under  another  and  more  important 
class  of  agents. 

Zinc  chlorid  in  various  strength  solutions  can  be  used  to  ad- 
vantage in  a  class  of  cavities  where  the  decay  or  softened  dentin  does 
not  extend  too  close  to  the  pulp.  Zinc  chlorid  coagulates  albumin,  and 
in  the  process  hydrochloric  acid  is  liberated.  For  this  reason  the  ap- 
plication of  strong  solutions  is  painful  and  should  not  be  employed  in 
deep  cavities  unless  the  irritating  action  of  the  agent  is  modified. 


HYPERSENSITIVE    DENTIN.  265 

This  can  be  done  to  a  marked  degree  by  selecting  alcohol  and  chloro- 
form  as  the  vehicle  in  which  to  make  the  solution. 
A  useful  formula  is  here  given: 

1$ — Zinci  Chloridi,  gr.  xx  (1.3  gm.) 

Alsoholis,  f5iv  (15.0  c.c.) 

Chloroformi,  q.  s.  ad.        foj  (30.0  c.c.) — M. 

Sig. — Apply  to  the  cavity  on  a  small  pledget  of  cotton  and  gently 

evaporate  to  dryness. 
Note. — If  the  zinc  salt  does  not  make  a  clear  solution  in  the  alcohol, 
it  indicates  that  some  of  the  salt  has  been  oxidized;  the 
solution  can  be  cleared  by  adding  one  drop  of  dilute  hydro- 
chloric acid. 

This  is  an  excellent  remedy  to  apply  to  the  cavity  immediately 
before  using  compressed  air. 

Trichloracetic  acid  in  concentrated  solution  causes  considerable 
pain  when  first  applied  to  a  sensitive  cavity,  therefore  defeating  the 
object  of  its  use;  but  in  a  10  or  15  per  cent,  solution  it  produces  but 
little  pain  or  inflammatory  reaction.  In  this  strength  it  can  be  em- 
ployed, but  not  always  with  satisfactory  results. 

Silver  nitrate  is  perhaps  the  only  known  prophylactic  drug  for 
decay  of  tooth-structure..  In  the  posterior  part  of  the  mouth  where  the 
cementum  is  exposed  to  external  influences  and  thus  sensitive  or  in 
shallow  cavities,  especially  in  children's  teeth,  the  use  of  this  drug,  in 
the  solid  pencil  form  or  in  various  strength  solutions,  will  be  found 
valuable,  both  as  a  means  of  reducing  the  sensitiveness  and  preventing 
further  ingress  of  caries.  As  an  agent  for  obtunding  the  sensitivity  of 
the  dentin  in  an  ordinary  cavity,  it  should  not  be  considered  for  various 
reasons.  When  the  agent  is  employed  for  the  purposes  above  men- 
tioned, the  cavity,  after  the  application,  should  be  kept  free  from  saliva 
for  a  few  minutes,  and,  if  possible,  exposed  to  sunlight,  thus  decom- 
posing the  silver  salt  as  referred  to  under  the  subject  of  Light  (seep.  235). 
A  solution  of  sodium  chlorid  should  always  be  at  hand  when  using 
silver  nitrate,  and  in  case  any  of  the  latter  agent  should  accidentally 
get  on  the  mucous  membrane  of  the  patient's  mouth,  its  action  can  be 
checked  at  once  by  rinsing  the  mouth  with  this  antidotal  solution. 

III.  LOCAL  ANODYNES  OR  LOCAL  ANESTHETICS. 

In  the  judicious  use  of  agents  belonging  to  this  class  the  author 
firmly  believes  will  ultimately  be  found  the  surest  and  safest  road  to 


266  PRACTICAL    DENTAL    THERAPEUTICS. 

success.     The  following  agents,  or  a  combination  of  two  or  more,  will 
be  found  to  be  of  the  utmost  importance: 


Cocain. 

Phenol. 

Menthol. 

Ethyl  Chlorid. 

Oil  of  Cloves. 

Ether. 

Eugenol. 

Chloroform. 

Cocain. — Both  the  alkaloid,  cocain,  and  the  alkaloidal  salt,  cccain 
hydrochlorid,  are  used  in  various  ways  for  obtunding  sensitive  dentin. 
An  important  physiologic  property  of  cocain  to  be  remembered  here 
is  its  power,  when  applied  directly  to  the  mucous  membrane  or  when 
injected  or  forced  into  the  pulp  tissue,  of  inducing  a  condition  of  anal- 
gesia in  the  part  by  paralyzing  the  sensory  nerve  filaments.  In  addi- 
tion to  this,  it  causes  a  blanching  of  the  part  which  is  subsequently 
followed  by  congestion.  It  should  also  be  remembered  that  pharma- 
cologists have  proved  beyond  a  doubt  that  cocain  is  a  general  proto- 
plasmic poison;  that  muscles  as  well  as  nerves  and  nerve-ends  cease 
to  contract  or  to  conduct  stimuli  when  they  are  exposed  to  even  dilute 
solutions  of  the  drug.  The  only  reason  that  the  deleterious  effect  is 
more  noticeable  upon  nerve  than  upon  other  kinds  of  tissue  is  that 
here  we  are  dealing  with  the  medium  of  sensation  and  expression. 

The  author  deems  it  wise  to  call  attention  to  these  well-established 
physiologic,  pharmacologic  and  pathologic  facts,  for  many  instru- 
ments have  recently  been  devised  for  forcing  various  strength  solu- 
tions of  cocain  hydrochlorid,  not  only  into  the  dentinal  tubuli,  thereby 
paralyzing  the  fibrillae,  but  into  the  pulp  proper,  anesthetizing  this 
organ  as  well.  In  view  of  these  facts,  it  would  appear  that  we  are 
never  justified  in  completely  anesthetizing  the  pulp  of  a  tooth  for  the  pur- 
pose of  painlessly  preparing  a  cavity  therein.  Therefore,  under  the 
subject  of  Cataphoresis  previously  referred  to,  little  was  written;  and 
for  the  same  reasons,  the  method  of  anesthetizing  the  pulp  by  high- 
pressure  anesthesia  for  obtundent  purposes  only  will  not  be  considered. 
Both  of  these  methods  will  be  discussed  subsequently  under  pulp 
removal. 

Cocain  and  the  alkaloidal  salt,  cocain  hydrochlorid,  are  safe  and 
valuable  agents  for  obtunding  sensitive  dentin,  if  confined  to  the  dentinal 
structure  of  the  tooth.  Frequently,  in  deep-seated  cavities,  especially 
in  children's  teeth,  the  sensitiveness  can  be  completely  overcome  by 
sealing  in  the  cavity  for  a  day  or  two  a  creamy  paste  made  by  mixing 
the  alkaloid  with  liquid  petroleum.  The  official  oleate  of  cocain  can 
also  be  used  for  this  purpose.     The  paste  or  oleate  should  cover  the 


HYP!  ^SENSITIVE    I>l  MIX.  267 

entire  surface  of  dentin  which  we  subsequently  expect  to  excavate. 
Good  results  can  also  be  immediately  obtained  by  the    use   of   the 

following  remedy: 

3— Cocainae,  gr.  xx  (1.3  gm.) 

Chloroformi,  f5ij  (8.0  c.c.) 

Etheris,  q.  s.  ad.     foj  (30.0  c.c.).— M. 

Sig. — After  the  rubber  dam  has  been  adjusted,  apply  to  the  cavity 
on  a  small  pledget  of  cotton  and  evaporate  to  dryness. 

In  the  use  of  this  remedy,  advantage  is  taken  of  the  physical  law 
previously  referred  to  in  connection  with  Cold.  As  the  volatile  liquids 
ether  and  chloroform  evaporate,  a  certain  amount  of  heat  is  abstracted 
from  the  tooth-structure,  and  a  coating  of  the  alkaloid,  driven  to  an 
extent  into  the  dentin,  is  left  in  the  cavity.  This  remedy  will  not  com- 
pletely obtund  all  sensitive  dentin,  but  its  use  will  be  a  material  aid. 

There  can  be  no  objection  in  favorable  cases,  provided  the  dentin 
has  been  previously  sterilized,  to  using  aqueous  solutions  of  cocain 
hydrochlorid  with  uniform  pressure  over  the  entire  area  of  the  cavity, 
thus  forcing  the  anesthetizing  solution  an  equal  distance  into  the  dentin. 
This  is  an  extremely  difficult  thing  to  do  without  forcing  the  solution 
at  some  more  favorable  point  in  the  cavity  through  the  tubuli  and  into 
the  pulp.  However,  there  are  cavities  where  good  results  can  be 
accomplished  by  the  careful  use  of  this  method.  In  some  cases  of 
gingival  cavities  good  results  can  be  obtained  by  hypodermically 
injecting  a  1  or  1.5  per  cent,  solution  of  cocain  hydrochlorid  into  the 
pericemental  membrane  somewhere  near  the  apex  of  the  root.  This 
practice  should  not  be  generally  recommended. 

Menthol  can  be  substituted  for  the  cocain  in  the  above  prescrip- 
tion with  ether  and  chloroform,  and  used  in  exactly  the  same  manner. 
An  oily  liquid  (mentho-chloral)  can.  be  formed  by  heating  together 
over  a  water-bath  or  rubbing  in  a  mortar,  an  equal  amount  of  menthol 
and  chloral.  This  remedy  will  be  found  efficacious  by  sealing  in  the 
cavity  for  a  few  days. 

Oil  of  Cloves. — A  profound  analgesic  effect  can  be  produced 
upon  sensitive  dentin,  especially  in  deep-seated  cavities,  by  using  oil 
of  cloves  and  heat  in  the  following  manner  as  suggested  by  Dr.  C.  X. 
Johnson:  After  carefully  desiccating  the  dentin  by  means  of  warm 
alcohol  and  gentle  heat,  a  pledget  of  cotton  saturated  with  oil  of  cloves 
should  be  placed  in  the  cavity  and  a  current  of  heated  dry  air  directed 
thereon  until  the  cotton  is  nearly  dry.  This  should  be  repeated  as 
often  as  the  case  demands. 


268  PRACTICAL    DENTAL    THERAPEUTICS. 

Eugenol  can  be  used  in  the  same  manner  as  above  described. 

Phenol  can  be  substituted,  with  equally  good  results,  for  the  oil 
of  cloves  or  eugenol,  as  described  in  the  foregoing  method.  Care 
should  be  taken  here,  however,  in  directing  the  heated  air  so  as  not  to 
cause  the  fumes  of  phenol  to  escape  on  the  patient's  face.  Oil  of 
cloves,  eugenol,  and  phenol  are  three  true  local  anodynes,  and  any  one 
of  which,  if  hermetically  sealed  in  a  cavity  for  a  few  weeks,  will  check 
the  continued  irritation  of  the  fibrillae  and  pulp,  thus  aiding  Nature  to 
restore  these  structures  to  their  normal  condition  when  they  should 
not  be  responsive.  The  author's  phenol  compound  (see  p.  273)  is 
an  excellent  remedy  for  this  latter  purpose.  By  this  means,  then,  the 
sensitiveness  of  the  dentin  can  also  be  allayed. 

Ethyl  chlorid,  ether,  and  chloroform,  by  their  rapid  volatility, 
produce  a  condition  of  analgesia,  thereby  obtunding  sensitive  dentin, 
as  previously  explained  under  Cold. 

IV.  GENERAL  ANODYNES  OR  ANALGESICS. 

In  order  to  do  permanent  work  for  certain  highly  nervous 
patients,  it  is  sometimes  necessary  to  resort  to  the  administration  of 
this  class  of  drugs.     The  agents  largely  used  for  this  purpose  are: 

Opium.  Nitrous  oxid. 

The  bromids.  Chloroform. 

Opium  is  a  most  powerful  analgesic,  and  while  there  are  some 
dental  conditions  where  this  drug  or  its  chief  alkaloid,  morphin,  is 
truly  indicated,  it  ought  not,  in  the  author's  judgment,  to  be  given  for 
the  treatment  of  sensitive  dentin. 

The  bromids  of  potassium,  sodium,  and  ammonium  are  valu- 
able drugs  in  certain  cases.  Perhaps  there  is  no  drug  which  will  quiet 
a  nervous  patient  more  readily,  when  the  nervousness  comes  purely 
from  fear  or  dread,  than  potassium  bromid,  which  is  the  representa- 
tive of  this  class.  In  such  cases,  where  it  is  deemed  necessary,  the 
following  prescription  will  prove  helpful: 

1$ — Potassii  bromidi,  ojss  (6.0  gm.) 

Syrupi  sarsaparillae  comp.,  f§iij  (90.0  c.c.) — M. 

Sig. — Take  a  tablespoonful  in  water  after  meals  the  day  before 
coming  to  the  office. 

Nitrous  Oxid. — There  are  several  apparatuses  on  the  market 
by  which  nitrous  oxid  gas  can  be  administered  through  the  nose. 
It  is  possible  with  such  an  apparatus  to  carry  the  patient  just  to  the 


Il\  I'l  RSI  NS1  I1VE    DEN  I  IN.  269 

analgesic  stage,  and  hold  him  under  its  Influence  until  a  sensitive  cavity 
has  been  painlessly  prepared.  In  cases  where  the  operator  feels  that  it 
is  necessary  to  resort  to  this  method,  good  results  can  be  accomplished. 

Chloroform.  With  the  patient  in  the  upright  position,  chloroform 
can  be  carried  to  the  analgesic  stage  and  sensitive  cavities  prepared. 
Most  authorities  agree,  however,  that  chloroform  should  not  be  ad- 
ministered unless  the  patient  is  in  the  recumbent  position,  and  that 
the  analgesic  stage  is  the  most  dangerous.  Death  has  been  known  to 
occur  suddenly  after  a  few  inhalations  in  cases  of  marked  idiosyncrasy 
against  the  drug. 

The  author  would  not  suggest  the  use  of  chloroform  for  this 
purpose. 

In  closing,  may  I  say  that  most  patients  who  repose  confidence  in 
the  operator,  are  sensible  and  are  willing  to  stand  some  pain  in  the 
preparation  of  cavities  in  their  teeth.  With  confidence,  a  true  running 
engine,  a  steady  hand,  a  sharp  bur,  and  with  the  aid  of  some  of  the 
many  remedies  herein  suggested,  the  operator  ought  not  to  expect 
nor  to  ask  the  patient  to  stand  more  than  a  small  amount  of  pain  in  the 
preparation  of  the  most  sensitive  cavity. 


EXPOSED  OR  NEARLY  EXPOSED  PULPS. 
GENERAL  CONSIDERATIONS. 

In  the  practice  of  dentistry  there  are  problems  continually  arising, 
wherein  it  is  difficult  for  the  conscientious  operator  to  decide  upon  a 
method  of  procedure  which  will  conserve  the  best  interests  of  the  patient. 
There  is  no  condition  confronting  us  with  greater  difficulty  of  treat- 
ing than  in  those  cases  where  the  decay  has  extended  to  such  a  depth 
that  its  thorough  removal  will  expose  or  nearly  expose  the  pulp.  The 
problem  to  be  solved  here  in  all  such  cases  is  to  decide  whether  it 
will  be  best  to  try  to  save  the  pulp  or  to  anesthetize  or  devitalize  this 
organ,  remove  it,  and  subsequently  fill  the  canals. 

Factors  to  be  Considered. — There  are  several  important  factors 
to  be  considered,  and  upon  which  will  largely  depend  the  success  or 
failure  following  an  attempt  to  save  the  pulp  after  it  has  actually  been 
exposed.  In  an  accidental  exposure  in  the  preparation  of  a  cavity,  the 
chances  for  saving  the  pulp,  provided  the  injury  has  not  been  too  great, 
are  far  more  favorable  than  if  the  pulp  had  been  exposed  by  the  neces- 
sary removal  of  the  carious  dentin.  Our  success  will  also  depend  in  no 
small  degree  upon  the  condition  of  the  pulp  as  well  as  upon  the  general 
condition  of  the  mouth  of  the  patient  in  which  the  exposure  occurs.  In 
cases  of  hyperemia  of  the  pulp  an  effort  should  be  made  to  determine 
whether  it  is  active  or  passive  hyperemia,  and  where  pulpitis  is  present 
our  prognosis  will  be  governed  largely  by  ascertaining  whether  the  pulpi- 
tis is  partial  or  complete,  or  of  the  nonseptic  or  septic  variety.  If  there 
is  congestion  or  any  evidence  of  degeneration  of  the  structural  compo- 
nents of  the  pulpal  organ  itself,  it  would  be  futile  to  attempt  to  cap  it. 
Logan  is  of  the  opinion  that  most  pulps,  the  exposure  of  which  has  been 
brought  about  by  caries,  have  undergone  sufficient  inflammatory  changes 
to  cause  their  ultimate  death,  even  when  carefully  capped.  Any  attempt 
to  permanently  save  an  exposed  pulp  in  the  mouth  of  a  patient  who 
was  suffering  from  some  systemic  derangements  interfering  with  the 
general  'circulation,  thus  lessening  vital  resistance,  would  doubtless 
result  in  failure  also,  for  in  such  cases  the  pulp  would  fail  to  receive 
from  the  blood  supply  the  necessary  elements  for  the  restoration  of  its 
functional  activity.  The  general  condition  of  the  mouth  itself  and  the 
care  it  receives  daily  from  the  patient,  is  an  essential  factor  to  be  taken 

270 


EXPOSED   Ok    MARIA     EXPOSED   PULPS.  271 

into  consideration  before  proceeding  to  rap  a   pulp,  for  Hopkins,  of 

Boston,  in  a  carefully  conducted  series  of  experiments  to  ascertain  the 
difference  in  virulency  of  certain  pathogenic  bacteria  in  different 
mouths,  and  in  the  same  mouth  under  different  conditions,  proved  that 
not  only  did  the  germs  proliferate  more  rapidly  in  neglected  and  uncared- 
for  mouths,  but  their  pathogenic  properties  are  greatly  increased. 

Exceptional  Cases  of  Exposure. — There  is  one  class  of  cases  of 
pulp  exposure  which  frequently  present  in  a  busy  practice  and  in  which 
it  is  our  plain  duty  to  make  the  attempt  to  restore  the  organ  to  its 
normal  function,  even  though  the  conditions  for  doing  so  are  not  alto- 
gether favorable.  I  mean  here  those  cases  in  the  mouths  of  young  pa- 
tients where  the  pulp  is  exposed  from  decay  and  the  roots  of  the  tooth 
have  not  been  fully  developed.  Every  effort  should  be  made  to  cap  such 
a  pulp  and  thereby  save  it,  if  for  only  a  year  or  two,  for  clinical  experience 
has  demonstrated  that  to  remove  the  pulp  and  properly  close  the  large 
openings  in  the  end  of  the  roots  is,  at  best,  a  difficult  procedure;  that  a 
tooth  in  this  condition,  thus  treated,  is  usually  a  source  of  annoyance 
and  its  usefulness  generally  of  short  duration. 

In  another  class  of  cases  the  author  also  believes  that  we  are  justi- 
fied in  capping  the  pulp.  For  instance,  in  those  cases  of  exposure 
where  for  certain  reasons  it  is  desirable  to  save  the  tooth,  and  on  which 
it  would  be  difficult  to  adjust  the  rubber  dam,  aseptically  remove  the 
pulp,  and  throughly  fill  the  canals.  I  wish  to  state  here,  however,  that 
I  do  not  mean  to  infer  that  a  pulp  should  be  capped  in  an  anterior  tooth, 
because  of  the  liability  of  the  tooth-structure  discoloring  after  the  pulp 
has  been  removed.  This  phrase  of  the  subject  will  be  referred  to  in 
detail  subsequently  under  the  Preservation  of  the  Color  of  the  Tooth 
in  Pulp  Removal. 

From  the  foregoing,  then,  it  should  readily  be  understood  that  no 
set  of  rules  can  be  given,  the  application  of  which  will  surely  lead  to 
success.  Every  case  must  be  studied  and  treated  according  to  the 
operator's  best  judgment  after  having  taken  into  consideration  all 
these  various  factors. 

THERAPEUTICS  OF  PULP  CAPPING. 

These  are  several  methods  of  capping  the  pulp,  each  differing  in 
minor  details,  such  as  the  use  of  various  cements,  gutta-percha,  con- 
cave metallic  disks,  etc.,  etc.  The  reader's  attention  will  first  be 
directed  to  the  general  precautions  to  be  taken  in  following  the  dif- 
ferent methods  of  capping;  after  which  one  method  will  be  described 


272  PRACTICAL   DENTAL    THERAPEUTICS. 

in  detail  which  has  proved  successful  in  the  author's  practice.  By 
this  I  do  not  mean  to  convey  the  idea  that  all  pulps  which  I  have  at- 
tempted to  save  have  been  rehabilitated  to  their  functional  activity — 
many  have  not;  however,  a  sufficient  number  of  those  thus  treated  have 
remained  quiet,  and  proved  years  later  to  be  vital,  to  justify  making 
the  attempt  where  the  case  demands. 

Precautions. — The  precautions  to  be  observed  in  following  any 
method  are: 

1.  By  the  use  of  an  anodyne,  the  hyperemic  pulp,  if  in  this  con- 
dition, must  be  restored  to  normal  before  the  final  capping. 

2.  The  dentin  overlying  the  pulp  must  be  thoroughly  sterilized. 
It  should  be  noted  here  that  the  usual  perfunctory  method  of  sterilizing 
the  dentin  by  simply  applying  a  germicidal  solution  to  the  cavity 
for  a  few  moments  does  not  sterilize  to  the  degree  necessary  for  success- 
ful results.  The  lack  of  thorough  sterilization  has,  without  doubt, 
been  the  chief  cause  of  failure  in  many  instances.  The  accuracy  of 
this  statement  will  be  seen  when  we  remember  that  our  greatest  success 
has  followed  the  capping  of  pulps  which  have  been  accidentally  exposed 
with  a  bur  or  instrument  in  preparing  a  cavity,  although,  in  most 
cases,  greater  mechanical  injury  had  been  caused  than  when  the 
exposure  was  due  to  caries  or  the  removal  of  carious  dentin. 

3.  Pressure  in  applying  the  material  for  capping,  or  the  cement 
which  covers  the  capping,  must  be  avoided. 

Technic. — After  breaking  down  all  overhanging  edges  of 
enamel  and  removing  as  much  of  the  debris  and  softened  dentin  as 
can  be  done  without  pain  or  injury  to  the  pulp,  the  cavity  should  be 
flooded  with  a  mild,  nonirritating,  antiseptic  solution,  previously 
heated  to  the  temperature  of  the  body.  For  this  purpose  the  author 
suggests  the  use  of  one  of  the  following  remedies: 

1$ — Phenolis,  foss  (2.0  c.c.) 

Aquae  menthse  piperitae,  fovj  (180.0  c.c.) — M. 

Sig. — Use  wherever  a  mild,  non-irritating  antiseptic  solution  is 
indicated. 

1$ — Alcoholis,  5j  (4.0  c.c.) 

Aquae  cinnamomi,  f5vj  (180.0  c.c.) — M. 

Sig. — Use  as  a  spray. 

These  solutions  can  be  used  as  a  spray  or  with  a  water  syringe 
before  applying  the  rubber  dam,  thus  adding  comfort  and  cleanliness 
to  the  operation.  The  excess  can  now  be  absorbed  from  the  cavity 
with  cotton  and  the  dam  adjusted.     By  using  some  obtunding  remedy 


I  X POSED    OK    MARIA     EXPOSED    PULPS.  273 

and  a  sharp  spoon  excavator,  or  oftentimes  a  large  round  bur  in  the 
engine,  the  carious  dentin  can  be  removed.  If,  however,  the-  thorough 
removal  of  all  the  softened  dentin  would  make  a  large  exposure,  it  is 
best  to  leave  the  layer  overlying  the  pulp  and  depend  upon  the  steriliz- 
ing agent,  rather  than  to  jeopardize  the  life  of  this  organ  by  the  injury 
thus  producer!.  The  delicate  pulp  tissue  will  not  tolerate  much  abuse 
and  remain  quiet,  therefore  if  it  is  injured  to  any  great  extent  it  had 
better  be  removed  at  once.  The  dentin  can  now  be  sterilized  by 
sealing  in  the  cavity,  for  a  week  or  two.  the  following  remedy  which 
is  not  only  germicidal  in  action,  but  possesses  marked  anodyne  prop- 
erties as  well: 

I!     Mentholis,  gr.  xx  (1 .3  gm.) 

Thymolis,  gr.  xl  (2.69  gm.) 

Phenolis,  (U.  S.  P.)  foiij  (12.0  c.c.)— M. 
Sig. — Use  as  directed. 

For  convenience  this  remedy  has  been  called  phenol  compound. 

It  is  best  to  seal  with  a  veneer  of  quick-setting  cement,  previously 
filling  most  of  the  cavity  with  cotton,  thereby  avoiding  pressure  and 
facilitating  the  subsequent  removal  of  the  dressing.  By  this  means 
the  dentin  can  be  thoroughly  sterilized,  and  the  pulp,  if  at  all  hyper- 
emic,  as  it  is  likely  to  be,  will  return  to  its  normal  condition. 

Many  pulps  have  been  irritated  by  the  injudicious  use  of  gutta- 
percha for  sealing  in  dressings  temporarily  or  for  separating  purposes 
where  proximal  cavities  exist.  Unless  due  care  is  taken,  even  where 
the  cavities  are  not  deep,  infectious  material  or  the  medicine  is  liable 
to  be  forced  through  the  dentin  and  into  the  pulp.  Cement  had  better 
be  used  for  temporary  sealing  purposes,  and  before  separating  with 
gutta-percha  the  cavity  should  be  cleaned  of  debris  and  sterilized. 

Thymol  has  a  peculiar  but  favorable  action  on  animal  tissue, 
and  for  this  reason  it  is  incorporated  in  the  above  prescription.  At 
the  next  sitting,  the  case  giving  a  favorable  history  for  the  interval. 
the  dam  should  always  be  applied,  the  teeth  included  sterilized,  and 
the  previous  dressing  carefully  removed,  when  the  exposure  and  dentin 
immediately  over  the  pulp  can  be  gently  covered  with  a  thin  paste 
made  by  mixing  thymolized  calcium  phosphate  with  the  oil  of  cloves 
or  eugenol.  A  prescription  for  the  thymolized  calcium  phosphate 
follows: 

J$ — Thymolis,  gr.  x  (0.6  gm.) 

•  Calcii  Phosp.  ppt.  (purificata),       5j  (32.0  gm.). — M. 
Sig. — Use  as  the  powder  for  making  paste. 
18 


274  PRACTICAL   DENTAL    THERAPEUTICS. 

The  paste  should  be  placed  on  one  side  of  the  cavity  and  gently  coaxed 
over  the  exposure  in  such  a  manner  as  to  exclude  the  air.  I  desire 
to  emphasize  the  importance  of  covering  the  entire  dentin  immediately 
over  the  pulp,  as  well  as  the  exposure,  with  this  antiseptic  and  non- 
irritating  paste.  By  this  means  we  prevent  the  phosphoric  acid  of 
the  cement,  used  to  cover  the  paste  and  to  temporarily  fill  the  cavity, 
from  irritating  the  pulp.  It  should  be  understood  that  this  paste 
is  only  intended  as  a  nonirritating,  antiseptic  covering  for  the  pulp. 
It  does  not  set.  To  bring  about  "setting,"  it  would  be  necessary 
to  use  a  substance  for  the  powder  and  an  acid  for  the  liquid  which 
react  upon  each  other.  This  would  cause  irritation,  thus  defeating 
our  object.  It  is  best,  as  intimated  here,  to  fill  the  entire  cavity  with 
cement  and  wait  for  a  few  months  or  perhaps  a  year  before  inserting 
the  permanent  filling  or  inlay.  Advantage  should  be  taken  of  every 
possible  means  of  preventing  subsequent  irritation  to  the  pulp.  For 
this  reason  largely  the  author  uses  precipitated  calcium  phosphate 
instead  of  calcined  zinc  oxid,  which  latter  substance  is  recommended 
by  many  writers.  The  powder  (largely  zinc  oxid)  which  comes  with 
a  package  of  cement  is  supposed  to  be  chemically  pure.  Those  who 
are  familiar  with  the  science  of  chemistry,  however,  know  that  arsenic 
is  found  associated  in  nature  with  many  of  the  metals,  among  which 
is  zinc;  and,  while  it  can  be  done,  it  is  difficult  to  obtain  these  metals 
or  their  oxids  free  from  arsenic.  It  is  well  in  those  cases  where  the 
pulp  is  not  quite  exposed,  to  add  a  small  amount  of  either  aristol  or 
europhen  to  the  paste.  These  are  iodin  compounds  and  are  used  as 
substitutes  for  iodoform.  Both  are  tasteless,  practically  without  odor, 
and  insoluble  in  water,  but  soluble  in  the  oil  used  as  the  vehicle  for 
the  paste,  therefore  only  a  small  amount  should  be  added. 

I  desire  to  emphasize  the  importance  of  studying  carefully  the 
conditions  as  found  in  each  case;  and  to  say  that  the  opportunity  here 
for  exercising  good  judgment  is  very  great,  and  that  there  is  a  satis- 
faction in  realizing,  whether  we  succeed  or  fail  in  our  effort  to  save  the 
pulp,  that  we  did  our  duty  as  we  saw  it. 


THE  RKMOVAL  OF  PULPS  AND  SUBSEQUENT 
TREATMENT. 

GENERAL  CONSIDERATIONS. 

Embryologists  claim  that  when  the  roots  of  a  tooth  are  fully  devel- 
oped, the  pulp  has  no  further  function  to  perform.  If  this  theory  can 
be  accepted  as  correct,  and  I  think  that  it  is  quite  well  established,  it 
would  appear  from  the  large  percentage  of  failures  following  the  most 
careful  methods  of  pulp  capping,  that  the  safest  and,  therefore,  the 
best  practice  would  be  to  destroy  the  vitality  and  remove  the  pulp  in  all 
cases  where  this  delicate  and  susceptible  tissue  had  been  previously  ir- 
ritated for  any  great  length  of  time,  unless,  as  explained  under  Ex- 
posed or  Nearly  Exposed  Pulps,  there  was  some  special  reason  for 
attempting  to  restore  the  organ  to  its  functional  activity.  From  sad  past 
experience  the  author  has  been  led  to  adopt  this  general  practice.  By 
this  I  do  not  wish  to  convey  the  idea  that  it  is  advisable  or  necessary  to 
injudiciously  or  ruthlessly  destroy  pulps,  for  such  is  not  the  case. 
It  is  the  plain  duty  of  every  dental  practitioner  to  save  the  pulps  of 
teeth,  if  it  can  be  done  with  any  reasonable  degree  of  success.  There 
are  many  conditions,  however,  which  necessitate  the  removal  of  the 
pulp,  such  as: 

i.  Dental  caries,  or  the  invasion  of  pathogenic  bacteria  and  the  ab- 
sorption of  ptomains.  This  is  perhaps  the  most  prolific  source  of  pulp 
irritation. 

2.  Mechanical  irritation,  due  to  such  causes  as  abrasion,  thermal 
changes,  close  proximity  of  metallic  fillings,  injudicious  regulating, 
excessive  grinding,  etc. 

3.  Calcific  deposits,  or  pulp  nodules,  partially  calcified  pulps,  and 
secondary  dentin.  These  calcific  deposits  result  from  slight  but  con- 
tinued irritation  of  the  pulpal  organ. 

4.  Crowning  teeth  and  filling  large  cavities. — It  is  usually  difficult 
to  grind  a  vital  tooth  sufficiently  to  adjust  the  band  for  a  crown  properly 
without  irritating  the  pulp  and  thus  endangering  its  life.  Sometimes  in 
filling  teeth  it  is  advisable  to  remove  the  pulp  in  order  to  properly 
anchor  a  large  filling  or  inlay. 

5.  Pyorrhea  alveolar  is. — Frequently  in  treating  this  disease  the 
best  results  can  be  accomplished  by  removing  the  pulp,  as  it  is  often  in  a 

275 


276  PRACTICAL    DENTAL    THERAPEUTICS. 

low  state  of  vitality,  and  its  removal  seems    to  stimulate  the  sluggish 
pericemental  membrane. 

General  Factors  to  be  Observed  in  Removal  of  Pulp. — Having 
considered  all  of  the  conditions  and  deciding  that  the  removal  of  the 
pulp  is  indicated,  the  method  by  which  this  can  be  accomplished  with 
the  least  inconvenience  to  the  patient  and  to  the  operator  is  the  most 
important  consideration.  Whatever  method  is  employed  in  the  removal 
of  pulps  from  teeth  and  the  subsequent  treatment,  there  are  at  least 
three  factors  to  be  observed,  viz. : 

1.  Establish  and  maintain  asepsis  in  performing  the  operation. 

2.  Preserve  the  color  of  the  tooth. 

3.  Thoroughly  fill  the  root. 

There  are  two  general  methods  employed  in  the  removal  of  pulps — 
anesthetization  and  devitalization. 

I.  ANESTHETIZATION. 

In  the  author's  opinion  a  very  satisfactory  method  of  removing 
pulps  from  teeth,  to  both  patient  and  operator,  all  things  considered 
and  conditions  being  favorable,  is  to  anesthetize  the  tissue  by  the  use  of 
various  strength  solutions  of  local  anesthetic  agents.  The  solutions 
are  forced  or  carried  through  the  dentin  and  into  the  pulp  by  means  of 
pressure  or  the  electric  current. 

1 .  PRESSURE  ANESTHESIA.— By  pressure  anesthesia  is  meant 
the  process  of  anesthetizing  the  pulp  by  forcing  solutions  of  local  anes- 
thetics, usually  cocain  hydrochlorid,  into  the  tissue  by  means  of  pressure. 
The  pressure  is  applied  either  by  using  unvulcanized  rubber  or  gutta- 
percha, and  a  blunt  instrument,  or  by  specially  devised  instruments  for 
this  purpose.  There  are  many  such  instruments  on  the  market;  and 
while  they  are  often  an  aid  in  accomplishing  the  ultimate  result,  they 
are  not  an  absolute  necessity. 

Sterilization. — The  rubber  dam  should  be  employed  in  every  case 
where  it  is  possible  to  adjust  it,  and  the  teeth  included  sterilized.  In 
cases  where  the  dam  cannot  be  adjusted,  it  would  doubtless  be  best  to 
remove  the  pulp  by  the  devitalization  method,  to  which  reference  will 
be  made  later,  for  in  using  the  method  under  consideration  care  must 
be  taken  to  prevent  pericementitis  following  the  operation;  and  one  of 
the  precautions  to  be  observed  in  preventing  this  result  is  to  thoroughly 
sterilize  the  cavity  before  applying  the  pressure.  It  should  be  re- 
membered that  the  majority  of  canals  which  contain  live  pulps  are 
sterile,  generally  speaking,  and  if  they  become  septic  at  any  time  be- 
fore the  root  is  filled,  it  is  the  fault  of  the  operator.     Thus  the  im- 


THE    REMOVAL   OF    PUI.l'S    WD    SUBSEQUENT   TREATMENT.         277 

portance  of  always  adjusting  the  rubber  dam,  using  sterile  instruments, 
and  having  in  a  convenient  and  conspicuous  place  an  antiseptic  doily 
on  which  to  wipe  the  blood  and  dry  the  instruments  used. 

Attention  is  again  directed  to  the  fact  that  the  usual  custom  of 
applying  coagulating  agents,  such  as  phenol,  cresol,  etc.,  to  the  cavity 
for  a  few  seconds  does  not  sterilize  the  dentin  to  the  degree  desired. 
The  best  results  are  accomplished  by  employing  germicidal  agents 
which  are  soluble  in  water.  In  cavities  where  the  decay  is  not  too  deep, 
the  dentin  can  be  sterilized  by  the  use  of  a  10  per  cent,  solution  of 
formaldehyd  to  which  5  per  cent,  of  sodium  borate  (borax)  or  sodium 
carbonate  has  been  added.  Where  the  decay  is  near  the  pulp  this 
solution  is  liable  to  cause  pain,  in  which  case  the  same  result  can  be  ac- 
complished by  the  use  of  a  1 :  500  solution  of  mercury  bichlorid  or  a 
1 :  200  solution  of  sublamin.  In  using  the  latter  solutions  the  pliers  on 
which  the  remedy  is  applied  should  be  wiped  immediately  on  an  anti- 
septic doily  to  prevent  the  mercury  from  acting  upon  the  instrument. 
One  of  the  best  solutions  with  which  to  chemically  sterilize  the  dentin, 
especially  in  those  cases  where  the  cavity  has  previously  been  filled  and 
the  tubuli  are  closed  and  perhaps  there  is  secondary  dentin,  is  a  25 
per  cent,  solution  of  sulphuric  acid.  Cook  recommends  using  pure 
sulphuric  acid  for  this  purpose.  The  solution  can  be  applied  to  the 
floor  of  the  cavity,  being  careful  not  to  get  the  agent  on  the  crown  of  the 
tooth.  After  a  few  minutes  the  excess  can  be  neutralized  with  a  solu- 
tion of  sodium  bicarbonate.  After  the  dentin  is  sterilized  the  cavity 
should  be  desiccated  with  warm  alcohol  and  gentle  heat,  when  we  are 
ready  to  use  the  anesthetizing  solution.  Before  taking  up  the  tech- 
nic  of  this  method,  however,  I  desire  to  again  emphasize  the  impor- 
tance and  necessity  of  cavity  sterilization.  In  our  discussion  later  of  the 
devitalization  method,  it  will  be  pointed  out  that  the  carious  and  in- 
fected dentin  can  be  completely  and  painlessly  removed  after  the 
devitalizing  agent  has  been  applied,  thus  mechanically  sterilizing  the 
cavity;  but  in  the  anesthetization  method  the  infected  dentin  is  sensi- 
tive and  cannot  be  removed  without  unnecessarily  producing  pain. 
The  dentin  in  this  case  must,  then,  be  sterilized  by  chemic  means,  for 
to  force  the  anesthetizing  solution  through  the  dentin  without  pre- 
viously sterilizing  it,  means  the  forcing  of  microorganisms  and  perhaps 
poisonous  ptomains  into  the  pulp  tissue  and  many  times  into  the  tissue 
surrounding  the  apical  end  of  the  root,  for  it  is  difficult  to  force  the 
solution  to,  and  only  to,  the  apex;  thus  too  much  pressure  and  the  lack 
of  thorough  sterilization  constitute  a  prolific  source  of  pericementitis 
following  the  removal  of  pulps  by  this  method. 


278  PRACTICAL   DENTAL   THERAPEUTICS. 

The  Solution. — With  the  cavity  thoroughly  sterilized  we  are  now- 
ready  to  use  the  anesthetizing  solution,  which  should  be  made  at  the 
time.  For  this  purpose  the  crystals  of  cocain  hydrochlorid,  previously 
powdered,  should  be  used  as  the  base,  and  freshly  distilled  or  boiled 
water  as  the  vehicle.  In  my  own  practice  I  use  the  flaked  cocain  hy- 
drochlorid as  the  base  and  my  regular  local  anesthetic  solution  as  the 
vehicle  for  making  the  stronger  solution.  A  prescription  for  the 
regular  local  anesthetic  solution  here  follows : 

1$ — Cocainse  hydrochloridi,  gr.  v  (0.3  gm.) 

Sodii  chloridi,  gr.  j  (0.06  gm.) 

Phenolis,  m.  ij  (0.13  c.c.) 

Aquae  menthae  piperita?,  foj  (30  c.c.) — M. 

Sig. — Use  as  a  local  anesthetic  for  hypodermic  injections. 

The  flaked  cocain  hydrochlorid  not  only  insures  a  pure  specimen 
of  the  drug,  but  facilitates  making  the  solution,  as  the  flakes  are  so 
readily  soluble.  There  is  no  advantage  in  using  the  above  solution 
over  distilled  or  boiled  water  or  freshly  prepared  peppermint  water, 
except  that  the  solution  is  always  at  hand  in  a  convenient  container 
and  is  sterile. 

The  thumb  and  forefinger  with  which  cotton  is  to  be  wrapped 
around  the  broach  should  be  sterilized  by  dipping  a  large  pledget  of 
cotton  in  10  per  cent,  formaldehyd,  or  1:500  mercury  bichlorid,  or 
1 :  200  sublamin  solution,  and  rolling  this  between  the  thumb  and  finger. 
A  small  amount  of  the  alkaloidal  salt  is  now  placed  on  a  clean  glass  slab 
and  a  pledget  of  cotton,  dipped  in  the  vehicle  selected,  a  few  drops  of 
which  have  previously  been  placed  on  one  end  of  the  glass  slab  or  in  a 
clean  glass  watch-crystal  or  other  container,  is  gently  placed  in  contact 
with  the  flakes,  when  the  latter  readily  dissolves,  making  a  strong  solu- 
tion. It  is  never  necessary  to  make  a  saturated  solution,  for  oftentimes 
better  results  will  be  obtained,  especially  if  the  solution  is  to  be  forced 
through  the  dentin,  if  the  strength  of  the  solution  approximates  only 
4  or  5  per  cent. 

Pressure. — The  cotton  thus  saturated  is  placed  in  the  cavity  as 
nearly  over  the  pulp  as  possible.  A  piece  of  unvulcanized  rubber 
which  will  approximately  fill  the  cavity  is  selected  and  passed  through 
the  flame.  There  are  two  objects  in  doing  this:  It  sterilizes  the  rub- 
ber and  also  makes  it  more  pliable,  in  which  form  it  conforms  readily 
to  the  cavity  of  the  tooth.  The  rubber  is  now  placed  in  the  cavity, 
and  by  means  of  gentle  but  firm  pressure  with  a  suitable  blunt  instru- 
ment the  solution   is  forced  through  the  dentin  and  into  the  pulp. 


THE    REMOVAL    OF    PULPS    AND    SUBSEQUENT     1RI  AIMI.VI.         279 

If  there  is  any  evidence  of  pain  as  the  pressure  is  applied,  it  should  be 
stopped  for  a  moment,  but  never  released.  The-  slight  pain  is  only 
momentary  and  is  an  indication  that  the  solution  is  being  confined 
under  the  pressure,  which  is  essential  for  the  success  of  this  method. 
It  may  he  necessary  in  those  cases  where  there  is  considerable  dentin 
between  the  cavity  and  the  pulp  to  make  two  or  three  applications 
before  the  pulp  is  reached  without  pain,  after  which  one  application 
should  complete  the  thorough  anesthetization  of  the  organ.  After  the 
first  application  a  small  depression  can  be  drilled  into  the  dentin  toward 
the  pulp,  in  which  the  solution  can  subsequently  be  placed,  thereby 
aiding  materially  in  confining  the  solution  under  the  pressure.  When 
an  exposure  exists,  it  requires  but  little  pressure  to  anesthetize  the  pulp. 
In  these  cases  the  cocain  hydrochlorid  can  be  placed  in  the  cavity  near 
or  over  the  exposure  and  the  pulp  gently  pricked  with  a  sharp  explorer, 
causing  it  to  bleed;  this,  if  done  carefully,  will  produce  very  little  pain. 
The  blood  will  dissolve  the  cocain  hydrochlorid,  when  pressure  can  be 
applied  and  the  pulp  anesthetized.  In  doing  this,  however,  there  is 
greater  danger  of  forcing  the  blood  into  the  tubuli  of  the  dentin  of  the 
crown  of  the  tooth,  thereby  making  it  more  difficult  to  remove  the  blood. 
Care  should  also  be  taken  not  to  force  the  solution  any  further  than  is 
necessary  for  the  painless  removal  of  the  pulp,  for  it  should  be  noted 
here  again  that  cocain  is  a  general  protoplasmic  poison,  and  if  even 
weak  and  sterile  solutions  are  forced  past  the  apices  of  the  roots  peri- 
cementitis is  almost  sure  to  follow. 

Confining  the  Solution  Under  Pressure. — In  removing  pulps 
by  pressure  anesthesia  without  employing  instruments  devised  for 
this  purpose,  the  best  results  are  obtained  in  cases  where  there 
are  four  walls  to  the  cavity,  for  in  this  condition  the  solution  is 
easily  confined  under  the  pressure.  In  proximo-occlusal  cavi- 
ties, the  missing  wall  can  be  built  temporarily  with  gutta-percha 
or  cement.  This  is  seldom  necessary,  however,  if,  in  packing  the 
rubber  in  the  cavity,  care  be  taken  to  cover  the  gingival  wall  first  and 
thus  seal  at  this  point,  then  working  the  rubber  over  the  occlusal  and 
gradually  creating  the  pressure.  Whatever  means  is  adopted  for  the 
purpose  of  confining  the  solution,  we  must  avoid  having  the  solution 
escape  at  the  gingival  margin  of  the  cavity  and  thereby  be  forced  into 
the  gum  tissue  and  pericemental  membrane.  The  cause  of  many  sore 
teeth  following  this  method  of  removing  pulps  can  be  traced  to  care- 
lessness or  ignorance  in  this  regard.  As  stated  elsewhere,  there  are 
many  ingeniously  dev'sed  instruments  on  the  market,  the  use  of  which 
is  often  a  material  aid  in  confining  the  solution  under  pressure  and 


280  PRACTICAL    DENTAL    THERAPEUTICS. 

forcing  it  through  the  dentin.  The  same  precautions  should  be  ob- 
served in  using  any  of  these  instruments  as  have  been  emphasized  in 
the  application  of  pressure  by  other  means. 

Opening  the  Pulp  Chamber  to  Expose  Canals. — When 
the  pulp  is  anesthetized,  the  pulp  chamber  should  be  opened  into 
in  such  a  manner  as  to  expose  the  canals.  This  is  best  accom- 
plished with  a  large  round  or  inlay  bur  by  means  of  which  the  entire 
roof  of  the  chamber  can  be  obliterated.  In  opening  into  the  pulp 
chamber  of  molar  teeth  care  should  be  taken  not  to  disturb  the  floor 
of  the  chamber,  for  by  so  doing  we  are  liable  to  add  to  the  difficulty  of 
entering  the  canals  with  a  broach.  While  we  are  never  justified  in 
drilling  unnecessarily  for  the  purpose  of  freely  exposing  the  canals, 
it  is,  if  necessary,  far  better  to  weaken  the  crown  of  the  tooth  somewhat 
by  this  means  rather  than  leave  a  portion  of  the  pulp  in  an  inaccessible 
canal  which  may  decompose  and  subsequently  cause  an  abscess. 

Selecting  and  Testing  Broaches. — The  selection  of  a  proper 
broach  is  an  important  matter.  Every  broach  should  be  tested  before 
entering  the  canal.  This  can  be  done  by  bending  it  in  various  direc- 
tions. If  the  broach  is  weak  in  any  particular  place  it  can  be  detected 
by  this  means;  thus  we  avoid  breaking  the  broach  in  the  canal,  the 
removal  of  which  is  often  a  difficult  procedure.  Many  good  operators 
claim  to  be  able  to  remove  all  pulps  by  using  a  smooth,  three-cornered 
broach  on  which  a  few  threads  of  cotton  are  wound.  Others  use 
twist  or  spiral  broaches.  In  all  large  canals  the  author  has  had  the 
most  satisfaction  from  the  use  of  a  barbed  broach.  The  broach  should 
be  gently  worked  along  the  side  of  the  canal  as  far  as  it  will  go 
without  using  too  much  force,  twisted  once  or  twice  to  entangle  the 
pulp,  and  then  withdrawn.  By  this  means  the  pulp  can  be  removed 
from  large  canals  in  its  entirety. 

Control  of  Ordinary  Hemorrhage  and  Removal  of  Blood. — 
In  the  removal  of  live  pulps  by  the  anesthetization  method,  there 
necessarily  would  be  more  hemorrhage  than  in  those  cases  where  the 
pulp  was  devitalized  before  attempting  to  remove  it.  However,  the 
control  of  hemorrhage  is  not  as  difficult  a  procedure  as  many  writers 
have  led  us  to  believe.  In  most  cases  the  hemorrhage,  if  undisturbed, 
will  be  checked  by  Nature's  method  in  a  few  minutes,  after  which  the 
blood  in  the  cavity  and  canal  should  be  thoroughly  removed.  I  desire 
here  to  emphasize  the  importance  of  removing  the  blood.  One  of  the 
factors  to  be  observed  in  extirpating  pulps  from  teeth  and  the  subse- 
quent treatment,  is  to  preserve  the  color  of  the  teeth.  The  cause  of 
many  teeth  darkening  after  the  pulp  has  been  removed  can  be  traced 


Mil     REMOVAL  Of    PULPS  AND   SUBSEQUEN1    TREATMENT.        251 

directly  to  the  failure  to  remove  the  blood  from  the  dentin  of  the  crown 
of  the  tooth.  The  far  too  prevalent  practice  of  wiping  out  the  bloody 
canal  with  a  solution  of  hydrogen  dioxid,  blindly  thinking  the  blood 
can  be  removed  by  this  means,  cannot  be  too  strongly  condemned. 
The  hydrogen  dioxid  simply  decomposes  the  blood  within  the  tooth- 
structure,  oxidizing  the  iron  of  the  hemoglobin;  and  the  gases  evolved 
in  the  decomposition  force  this  pigment  into  the  tubuli,  which,  if  left 
and  it  is  difficult  to  remove  it),  will  cause  the  tooth  to  darken  in  almost 
every  instance.  Therefore,  we  should  avoid  forming  within  the 
tooth-structure  a  pigment  which  we  know  will  discolor  teeth.  The 
color  of  a  tootli  docs  not  depend  upon  the  life  and  vitality  of  the  pulp, 
but  upon  the  array  of  colors  in  the  dentin  which  are  reflected  through  tin 
nearly  colorless  and  transparent  enamel.  If,  then,  these  colors  are  not 
changed  by  our  failure  to  remove  the  blood  or  by  the  use  of  staining 
remedial  agents  in  the  subsequent  treatment  following  pulp  removal, 
the  tooth   will  not  discolor. 

To  remove  the  blood  from  the  canal,  alcohol  can  be  used,  or  even 
better  than  this  agent  is  Nature's  greatest  solvent,  water.  The  water 
should,  of  course,  be  sterile,  and  the  same  specimen  can  be  employed 
here  as  was  used  in  making  the  anesthetizing  solution,  i.e.,  freshly 
distilled  or  boiled  water,  or  peppermint  water  to  which  two  minims 
of  phenol  has  been  added  to  the  fluidounce.  If  convenient,  a  little 
sodium  chlorid  (common  salt)  can  be  added  to  the  water.  By  this 
means  the  blood  can  be  completely  removed,  not  decomposed  in  the 
canal  and  forced  into  the  structure  of  the  tooth. 

Small  Canals. — There  are  many  canals  so  small  and  tortuous  that 
even  a  fine  broach  will  not  enter,  to  any  depth  at  least.  In  these  cases, 
after  the  hemorrhage  from  the  larger  canals  has  been  checked  and  the 
blood  removed,  the  pulp  tissue  in  the  small  canals  can  be  disorganized 
by  the  use  of  strong  solutions  of  mineral  acids  or  alkalies.  The  author 
prefers  making  a  paste  of  sodium  dioxid  and  absolute  alcohol,  placing  the 
paste  in  the  pulp  chamber  over  the  small  canals,  and  working  it  down 
as  far  as  possible  with  a  smooth  broach.  The  alcohol  gradually  evap- 
orates, when  the  sodium  dioxid  can  be  decomposed  into  oxygen  and 
caustic  soda  by  placing  a  pledget  of  cotton  in  the  cavity  moistened 
with  distilled  water.  After  the  reaction  has  taken  place,  the  alkali  can 
be  neutralized  with  a  weak  solution  of  sulphuric  acid  (2  per  cent.). 
This  process  can  be  repeated  until  the  desired  end  is  attained.  There 
are  other  means  by  which  the  same  results  can  be  accomplished,  such 
as  the  use  of  a  50  per  cent,  solution  of  chemically  pure  sulphuric  acid, 
strong  solutions  of  potassium  or  sodium  hydroxid,  or  a  mixture  of 


282  PRACTICAL    DENTAL    THERAPEUTICS. 

metallic  potassium  and  sodium  (Schreier's  paste).  These  same 
agents  can  be  used  to  advantage  for  the  purpose  of  disposing  of  a 
remnant  of  a  pulp  in  larger  canals.  It  is  not  safe  to  anesthetize  this 
remnant  by  means  of  pressure.  The  only  cases  on  record  to  my  knowl- 
edge, where  toxic  symptoms  have  resulted  from  the  removal  of  a  pulp 
by  pressure  anesthesia,  followed  an  attempt  to  anesthetize  a  remnant 
of  a  pulp  or  in  making  the  second  application  of  the  anesthetizing 
solution. 

After-Treatment. — After  the  pulp  has  been  removed  and  the 
canals  dehydrated  with  alcohol  and  heat,  an  anodyne  treatment  is  indi- 
cated. For  this  purpose  such  drugs  as  phenol,  oil  of  cloves,  or  eugenol 
can  be  employed.  The  author  suggests  here  phenol  compound,  to 
which  attention  was  called  under  Exposed  or  Nearly  Exposed  Pulps. 
In  using  any  of  these  remedies,  especially  the  last-named,  it  is  best 
to  insert  dry  cotton  in  the  canal  and  then  place  a  pledget  dipped  in 
the  remedy  in  the  pulp  chamber  and  seal  with  cement  or  temporary 
stopping.  The  dry  cotton  in  the  canal  will  absorb  the  moisture  from 
the  apical  end  of  the  root  and  the  anodyne  remedy  from  the  pulp 
chamber.  There  is  an  advantage  in  using  the  dry  cotton,  for  it  is 
almost  impossible  to  completely  dehydrate  the  canal  at  this  sitting. 
If  asepsis  has  been  maintained  in  removing  the  pulp,  all  that  is 
necessary  is  to  keep  the  canal  in  this  condition  until  the  root  can  be 
filled;  therefore,  only  a  very  small  amount  of  the  remedy  should  be 
used.     The  tendency  here  is  to  use  too  much. 

When  to  Fill  Canals.— The  canals  should  not  be  filled  at  the 
sitting  at  which  the  pulp  has  been  removed  by  pressure  anesthesia 
unless  there  be  some  exceptional  reason  for  doing  so.  There  are 
many  good  reasons  why  the  canal  should  not  be  filled  at  this 
sitting: 

1.  While  it  is  our  object  to  force  the  solution  just  sufficiently  to 
anesthetize  the  pulp,  our  main  object  is  to  remove  the  pulp  absolutely 
without  pain,  and  it  is  very  difficult  to  force  the  solution  to  the  end  of 
the  root  without  forcing  it  through  the  apex  and  anesthetizing  the 
tissue  in  the  apical  area  to  some  extent.  With  the  tissue  anesthetized, 
we  would  have  no  guide  as  to  when  the  root  was  thoroughly  filled. 

2.  The  tearing  away  of  the  pulp  from  its  connection  at  the  apex 
causes  more  or  less  irritation,  and  a  few  days  should  elapse  to  give 
Nature  a  chance  to  readjust  the  condition.  The  root  filling  would  only 
serve  at  this  time  to  further  irritate  the  tissues. 

3.  Sometimes  with  the  utmost  care  in  removing  the  pulp,  second- 
ary hemorrhage  ensues  with  the  formation  of  a  clot  in  the  apical  area, 


THE    REMOVAL   OF   PULPS  AND    SUBSEQUEM     IKI   MMENT.         283 

causing  soreness,  in  which  case  greater  comfort  can  be  given  the 
patient  by  the  proper  treatment  through  the  root-canal  than  simply 
by  counterirritation  or  external  treatment  only. 

At  the  second  sitting,  the  case  giving  a  favorable  history,  the 
canals  should  be  filled. 

Excessive  Hemorrhage. — There  are  cases  occasionally  where 
Nature  does  not  stop  the  hemorrhage  as  readily  as  we  desire.  In  these 
exceptional  cases  the  hemorrhage  must  be  stopped  by  artificial  means, 
even  at  the  possible  expense  of  producing  pericementitis.  Cauterizing 
agents  are  useful  here.  For  this  purpose  95  per  cent,  phenol  or  a  15  per 
cent,  solution  of  trichloracetic  acid  can  be  worked  down  into  the  canal 
against  the  injured  and  bleeding  tissue,  after  which  the  anodyne  treat- 
ment is  employed  as  usual.  Where  the  above  treatment  does  not 
produce  the  desired  result,  cotton  saturated  with  a  fresh  1  :i  ,000  solution 
of  adrenalin  chlorid  can  be  placed  in  the  canal  and  with  unvulcanized 
rubber  forced  into  the  tissue  beyond  the  end  of  the  root.  This  should 
only  be  used  in  extreme  cases  because  of  the  soreness  it  is  liable  to 
produce. 

Objections  to  the  Use  of  Adrenalin  Chlorid. — In  this  connec- 
tion I  desire  to  discuss  the  use  of  solutions  of  adrenalin  chlorid  as  the 
vehicle  for  making  the  anesthetizing  solution,  or  the  use  of  adrenalin 
chlorid  and  cocain  hydrochlorid  tablets  for  anesthetizing  the  pulp. 
The  adrenalin  chlorid  has  been  suggested  as  a  means  of  preventing 
hemorrhage.  Now,  it  ought  to  be  evident  to  anyone  who  has  studied 
this  subject  that  to  prevent  hemorrhage  by  the  use  of  any  hemostatic 
agent,  it  is  necessary  to  force  the  agent  into  the  tissue  from  which  the 
hemorrhage  comes.  Therefore,  to  get  the  effect  of  the  adrenalin 
chlorid  in  removing  pulps  by  pressure  anesthesia,  it  is  absolutely 
essential  that  the  anesthetizing  solution,  which  also  contains  the  hemo- 
static agent,  be  forced  through  the  apex  and  into  the  apical  area — 
the  very  thing  we  have  been  taught,  from  sad  experience,  not  to  do. 
When  we  remember  that  the  majority  of  pulps  we  are  called  upon  to 
remove  are  those  in  which  there  is,  or  has  been,  more  or  less  pulpitis, 
and  when  we  remember  also  that  pathology  teaches  that  this  condition 
is  frequently  associated  with  pericementitis,  it  is  questionable  whether 
or  not  we  ought  to  prevent  hemorrhage  in  removing  pulps  from  teeth. 
For  to  permit  the  escape  of  blood  from  the  hyperemic  tissue  at  the  end 
of  the  root  is  one  of  the  best  means  of  aiding  nature  to  readjust  the 
abnormal  to  the  normal  condition.  In  case  the  primary  hemorrhage 
has  been  prevented  by  the  use  of  hemostatic  agents,  such  as  adrenalin 
chlorid,  secondary  hemorrhage  is  almost  certain  to  follow  with   the 


284  PRACTICAL    DENTAL    THERAPEUTICS. 

formation  of  a  clot,  the  absorption  of  which  in  the  apical  area  is  an 
extremely  slow  and  tedious  process. 

2.  CATAPHORESIS. — Cataphoresis,  as  has  been  elsewhere  ex- 
plained, is  a  term  applied  to  the  process  of  carrying  medicinal  agents 
in  solution  into  the  various  tissues  and  organs  of  the  body  by  means  of 
the  electric  current.  There  is  a  variety  of  cataphoric  outfits  on  the 
market.  To  anesthetize  a  pulp  by  this  means  the  tooth  should  be  in- 
sulated by  the  rubber  dam,  care  being  taken  that  no  moisture  escapes 
from  the  gum.  A  small  pledget  of  cotton  saturated  with  the  anesthetiz- 
ing solution  is  now  placed  in  the  cavity,  the  positive  pole,  or  anode, 
applied  to  the  solution,  and  the  negative  pole,  or  cathode,  moistened 
with  water,  applied  to  some  part  of  the  patient's  body,  usually  the  hand, 
thus  completing  the  circuit.  A  steady  and  continuous  current  is  de- 
sired, and  the  perfected  instruments  are  so  devised  that  the  amount  of 
current  can  be  measured.  The  time  required  to  anesthetize  the  pulp 
by  this  means  depends  largely  upon  the  density  of  the  dentin  and  the 
perfection  of  the  instruments  used.  With  the  pulp  anesthetized,  the 
same  method  of  removing  and  the  subsequent  treatment  is  followed  as 
in  pressure  anesthesia.  Cataphoresis,  while  successful  in  the  hands  of 
those  who  mastered  the  technic,  never  became  popular,  largely  because 
of  the  time  required  to  accomplish  the  result  and  because  of  the  com- 
plicated and  expensive  apparatus  necessary. 

If  the  method  of  anesthetizing  the  pulp  be  followed  and  the  pre- 
cautions observed  as  detailed  here,  it  will  be  found  that  there  are  few 
pulps  which  will  not  yield  to  the  influence  of  cocain  hydrochlorid.  It 
takes  time,  however,  to  adjust  the  rubber  dam,  sterilize  the  cavity,  re- 
move the  pulp  and  blood  from  the  canal  and  seal  in  the  anodyne  remedy. 
Many  times  the  operator  is  not  able  at  this  sitting  to  give  the  necessary 
time  to  complete  this  operation.  There  are  cases  also  where  the  condi- 
tion or  the  location  of  the  tooth  in  the  mouth  is  such  as  to  make  the 
removal  of  the  pulp  more  favorable  by  another  method  which  will  now 
be  considered. 

II.  DEVITALIZATION. 

In  discussing  Sensitive  Dentin  under  the  subject  of  escharotics  or 
caustics,  reference  was  made  to  the  fact  that  there  were  many  drugs  be- 
longing to  this  class  of  agents  that  could  not  be  employed  in  the  treat- 
ment of  sensitive  dentin,  for  the  reason  that  they  were  penetrating  and 
had  the  same  deleterious  effect  upon  the  cells  of  the  pulp  tissue  as  upon 
the  dentinal  nbrillae.     Some  of  the  agents  which  cannot  be  used  for 


NIK   REMOVAI     0]     1M   LPS    Wl>    B1  BSEQ1   l\i     l  HI  \l.MI\T.        285 

allaying  the  sensitiveness  of  dentin  are  exceedingly  valuable  and  are 
employed  for  the  purpose  of  destroying  the  vitality  of  the  pulp,  thus 
aiding  in  its  painless  removal.  The  most  prominent  of  these  agents  is 
ursolic  trioxid  (As203),  formerly  called  arsenious  acid.  The  agent 
was  first  advocated  to  be  used  in  the  treatment  of  sensitive  dentin  by 
Dr.  Spooner,  of  Montreal,  who  discovered  that  by  sealing  the  drug  in  a 
cavity  for  a  few  days  the  most  sensitive  dentin  yielded  to  its  influence, 
The  fact,  however,  that  nearly  all  teeth  thus  treated  subsequently  gave 
trouble  because  of  the  death  of  the  pulp  and  the  usual  sequelae,  led  the 
profession  to  abandon  this  agent  for  the  purpose  for  which  it  was  in- 
troduced; but  it  has  ever  since  been  used  as  a  means  of  destroying  the 
vitality  of  the  pulp.  In  fact,  for  years  it  was  the  only  agent  employed 
with  any  satisfaction. 

The  Preparation. — There  has  been  much  difficulty  experienced 
in  the  use  of  arsenic  trioxid,  largely  because  of  the  uncertainty  of 
the  preparations  employed.  Many  arsenical  preparations  are  on  the 
market.  The  white  powder  can  be  used  by  moistening  a  small 
pledget  of  cotton  with  some  liquid,  such  as  phenol,  cresol,  creosote,  or 
oil  of  cloves,  then  by  touching  the  cotton  to  the  powdered  arsenic 
trioxid,  a  sufficient  amount  will  adhere  which  should  be  transferred 
to  the  cavity  and  sealed,  preferably  with  cement.  It  is  well  for  each 
operator  to  select  an  arsenical  preparation  with  which  he  can  obtain 
good  results,  and  then  this  should  be  used  to  the  exclusion  of  all  others. 
By  this  means  only  can  we  become  thoroughly  familiar  with  the  action 
of  the  preparation  employed.  The  following  formula  is  here  given  for 
those  preferring  a  paste. 

1$ — Arseni  trioxidi,  oj  (4.0  gm.) 

Cocainae,  gr.  x  (0.6  gm.) 

Thymolis,  gr.  v  (0.3  gm.) — M. 

Fiat  Unguenta. 
Sig. — Apply  a  small  amount  to  the  dentin  immediately  over  the 

pulp. 
Note. — A  sufficient  amount  of  lampblack  may  be  added  to  color 
the  paste. 

I  wish  to  state  here  something  about  the  pharmacy  of  this  pre- 
scription, for  if  the  preparation  does  not  work  satisfactorily,  it  has  not 
been  properly  compounded.  Arsenic  trioxid  is  the  base,  cocain  is  a 
local  anesthetic,  and  when  applied  to  the  pulp  produces  a  condition  of 
analgesia  by  which  the  irritating  action  of  the  arsenic  trioxid  is  without 
effect,  and  thus  prevents  the  tooth  from  aching  while  the  pulp  is  being 
devitalized.     With  the  alkaloidal  cocain  and  thymol  a  nice  paste  can 


286  PRACTICAL    DENTAL    THERAPEUTICS. 

be  made  with  the  arsenic  trioxid.  The  author  prefers  a  fiber  which 
is  made  from  the  same  formula  as  above,  except  liquid  petroleum  is 
added,  and  the  whole  thoroughly  incorporated  in  some  fibrous  vehicle. 
The  fiber  may  be  colored  so  that  it  is  of  a  different  color  from  the 
ordinary  cement,  which  is  used  to  seal  the  preparation  in  the  cavity. 

Technic  of  Application. — In  those  cases  where  the  tooth  has 
ached  before  the  patient  presents  for  treatment,  it  is  always  the  best  prac- 
tice to  allay  the  pain  for  at  least  twenty-four  hours  before  attempting  to 
devitalize  the  pulp.  In  any  case,  whether  the  tooth  has  ached  or  not, 
before  applying  the  arsenical  preparation  or  before  adjusting  the  rubber 
dam,  it  is  best  to  break  down  all  overhanging  edges  of  enamel  and  care- 
fully remove  or  wash  out  with  a  nonirritating  antiseptic  solution  any 
food-stuffs  or  debris  which  may  be  in  the  cavity.  Food-stuffs  contain 
albumin,  and  if  such  is  in  the  cavity  of  the  tooth  when  the  arsenical  prep- 
aration is  applied,  the  arsenic  trioxid  will  act  upon  the  albumin,  form- 
ing arsenic  albuminate,  and  thereby  a  certain  amount  of  the  agent  is 
neutralized  or  becomes  inert.  As  much  of  the  carious  dentin  should 
also  be  removed  as  can  be  done  without  producing  pain,  for  the  applica- 
tion should  be  made  to  a  sensitive  spot  in  the  cavity.  It  is  never 
necessary  to  have  an  exposure  of  the  pulp;  and  in  case  an  exposure 
exists,  it  is  just  as  well  to  apply  the  preparation  to  the  dentin  im- 
mediately over  the  pulp,  rather  than  to  the  organ  itself,  though  in  using 
the  fiber  suggested  here  there  is  no  logical  reason  why  it  should  not  be 
applied  directly  to  the  exposed  pulp.  In  any  event  the  preparation 
should  be  covered  with  cotton  or  small  metallic  or  paper  disk  to  prevent 
pressure  and  also  to  prevent  the  phosphoric  acid  of  the  cement  from 
coming  in  contact  with  the  ingredients  of  the  preparation. 

Length  of  Time  Application  Should  Remain. — There  are  at 
least  four  factors  which  govern  the  length  of  time  an  arsenical  appli- 
cation should  remain  sealed  within  a  tooth,  viz. : 

i.  The  age  and  general  condition  of  the  patient. 

2.  The  general  condition  of  the  pulp  itself. 

3.  The  amount  and  condition  of  the  dentin  intervening  between 
pulp  proper  and  the  application  of  the  preparation. 

4.  The  climate  or  season  of  the  year,  strange  as  it  may  seem,  in- 
fluences the  action  of  arsenic  trioxid. 

Taking  into  consideration  these  various  factors,  the  arsenical  prep- 
aration should  remain  in  the  cavity  from  two  to  six  days.  At  the 
second  sitting  the  rubber  dam  should  be  adjusted,  the  teeth  included 
sterilized,  and  the  cement  and  preparation  removed,  after  which  every 


THE    REMOVAL   OF   PULPS  AND    SUBSEQUENT   TREATMENT.         287 

surface  of  the  cavity  should  be  freshened  with  a  large  round  bur.  This 
not  only  insures  the  thorough  removal  of  the  arsenical  preparation,  which , 
should  a  portion  remain,  is  liable  to  produce  pericemental  inflammation, 
but  it  also  mechanically  sterilizes  the  cavity  by  removing  the  carious  and 
infected  dentin.  This  is  important  and  is  an  aid  in  maintaining  asepsis 
in  the  removal  of  the  pulp.  In  the  author's  judgment,  this  is  much 
better  practice  than  to  depend  upon  a  solution  of  dialysed  iron  to 
neutralize  the  arsenic  trioxid. 

Opening  Pulp  Chamber  and  Exposing  Canals. — The  pulp 
chamber  can  now  be  opened  into,  observing  practically  the  same 
details  in  removing  the  tissue  and  after-treatment  as  explained 
under  the  anesthetization  method.  Oftentimes,  in  the  initial  open- 
ing into  the  pulp  chamber,  and  sometimes  on  entering  the  canal, 
after  the  application  of  arsenic  trioxid,  the  patient  will  experience  some 
pain;  but  by  gently  working  the  broach  up  the  side  of  the  root,  very 
little,  if  any,  pain  need  be  produced  in  removing  the  pulp,  provided,  of 
course,  the  tissue  is  devitalized.  However,  should  pain  be  exper- 
ienced, it  is  best  to  seal  the  phenol  compound  in  the  cavity  in  contact 
with  the  tissue  from  one  week  to  ten  days,  when  it  can  be  removed 
without  pain. 

Objections  to  the  use  of  Dialysed  Iron  and  Tannic  Acid. — 
In  connection  with  the  preservation  of  the  color  of  the  tooth,  under 
the  anesthetization  method  the  author  stated  his  objection  to  the  use 
of  hydrogen  dioxid  for  removing  the  blood  from  the  cavity  and  canal. 
It  is  necessary  here,  also,  to  refer  briefly  to  a  well-established  practice  of 
treating  teeth  after  the  pulps  have  been  devitalized.  It  is  the  practice 
of  many  dentists,  after  removing  the  arsenical  dressing,  to  flood  the 
cavity  with  a  solution  of  dialysed  iron,  after  which  the  pulp  chamber 
is  opened  into,  usually  producing  some  hemorrhage;  then,  without  any 
especial  effort  being  made  to  remove  the  dialysed  iron  or  blood,  tannic 
acid  in  some  form  is  sealed  in  contact  with  the  pulp  for  a  week  or  ten 
days,  thinking  it  advantageous  by  this  means  to  constringe  and 
toughen  the  tissue  before  attempting  its  removal.  Let  us  consider  the 
rationalism  of  such  treatment.  The  pulp  tissue  in  all  large  canals  is 
sufficiently  tough  to  be  removed  in  its  entirety,  and  it  must  be  disor- 
ganized or  removed  piecemeal  in  small  canals,  whether  it  has  been  pre- 
viously constringed  or  not.  Hence,  there  is  no  advantage  in  using 
tannic  acid,  and  there  is  a  serious  objection.  If  those  who  follow  this 
practice  are  observing,  they  will  notice  that  after  removing  the  tannic 
acid  dressing,  the  pulp  tissue  is  dark  in  appearance.  They  will  also 
observe   that   many   teeth   thus  treated   subsequently  discolor.     The 


288  PRACTICAL    DENTAL    THERAPEUTICS. 

cause  for  this  is  found  in  the  fact  that  tannic  acid  and  iron,  in  any  form, 
are  chemically  incompatible,  the  resulting  compound  being  iron  tannate, 
one  of  the  most  insoluble  substances  known  to  chemistry.  In  the 
presence  of  moisture  a  form  of  ink  is  produced  which  is  a  great  staining 
agent  for  dentin,  and  one  that  is  almost  impossible  to  remove  by  any 
known  process  of  bleaching. 

As  has  been  stated  elsewhere,  there  are  cases  where,  for  want  of 
time  or  other  reasons,  the  pulp  can  be  removed  to  advantage  by  devitali- 
zation; however,  when  this  method  is  followed  tannic  acid  should  not  be 
used,  and  every  trace,  of  dialysed  iron  (if  used  at  all,  and  it  is  unnecessary 
to  use  it)  and  blood  should  be  removed  with  alcohol  or  water. 

When  to  Fill  Canals. — In  those  cases  where  we  are  certain  that 
the  pulp  is  all  removed  and  where  the  canals  can  be  thoroughly  dried, 
the  root  filling  can  be  inserted  at  the  same  sitting,  proving  there  are 
no  symptoms  of  pericementitis  in  the  apical  area.  There  are  many  good 
reasons,  however,  for  not  filling  the  root  at  this  time,  some  of  which 
have  been  considered  under  the  anesthetization  method.  Where  the 
method  has  been  followed  of  delaying  the  removal  of  the  devitalized 
tissue  until  it  has  become  thoroughly  impregnated  with  the  thymol 
in  the  phenol  compound  the  canals  can  be  filled  at  the  time  the 
tissue  is  removed.     The  author  prefers  this  method. 

COMPLICATIONS.— In  our  discussion  thus  far  of  the  methods  of 
removing  pulps  from  teeth,  we  have  considered  only  favorable  cases, 
selecting  the  method  best  adapted  to  the  case  at  hand.  There  are  many 
instances,  however,  where  it  is  difficult  to  remove  the  pulp  by  either  the 
anesthetization  or  devitalization  method,  at  least  until  the  tooth  is 
placed  in  a  more  favorable  condition. 

Hypertrophied  Gum  Tissue. — Oftentimes  in  approximating 
cavities  the  decay  in  one  or  both  teeth  has  extended  far  beneath  the 
gum,  the  rough  gingival  margin  of  the  cavity  acting  as  a  slight  irritant 
by  which  the  gum  tissue  is  stimulated,  causing  it  to  proliferate  until  it 
fills  a  portion  of,  and  in  some  instances  the  entire,  cavity.  In  such 
cases  the  first  consideration  is  to  dispose  of  the  hypertrophied  tissue. 
Where  the  gum  fills  only  a  portion  of  the  cavity  and  the  pulp  of 
the  tooth  is  not  causing  trouble,  the  cavity  should  first  be  en- 
larged and  washed  with  a  warm  antiseptic  solution,  after  which 
it  should  be  dried  as  well  as  possible  and  packed  with  warm  gutta- 
percha. But  in  those  cases  where  the  gum  tissue  occupies  the  entire 
cavity,  and  especially  where  the  tooth  is  aching,  it  should  be  removed  at 
once.  Hypertrophied  gum  tissue  is  quite  tough  and  fibrous,  and  if  it  is 
elevated  or  pushed  back  by  means  of  a  flat  instrument,  it  will  usually  be 


Nil-:   REMOVAL   OF   PULPS  AND   SUBSF.QI  I  VI     IKI  AI.MI  NT.        289 

found  thai  the  attachment  at  the  gingival  margin  is  small  and  can  easily 
be  severed  by  employing  gum  scissors  or  a  lancet,  previously  dipped  in 
phenol.  It  is  best  not  to  tell  the  patient  what  you  are  going  to  do,  for 
scarcely  any  pain  will  be  experienced.  The  hemorrhage  in  these 
es  is  usually  profuse,  but  can  readily  be  stopped  by  cauterization 
with  95  per  cent,  phenol  or  a  15  per  cent,  solution  of  trichloracetic  acid. 
The  blood  should  now  be  thoroughly  removed,  the  cavity  dried, 
moistened  with  eucalyptol,  and  packed  with  gutta-percha,  letting  it 
extend  buccally  and  lingually  to  fill  the  interproximal  space.  The 
gutta-percha  can  be  removed  from  the  interior  of  the  cavity  with  a  heated 
Hat  instrument.  Quite  often  the  most  practical  way  of  adjusting  the 
rubber  dam  in  these  cases  is  to  place  the  clamp  on  the  tooth  posterior  to 
the  one  thus  packed,  having  a  single  hole  in  the  dam  include  both  teeth. 
The  packing,  if  properly  placed,  will  prevent  leakage.  The  pulp  can 
now  be  removed  by  the  method  which  the  operator  deems  the  most 
feasible. 

Importance  of  a  Correct  Diagnosis  as  to  the  Kind  of  Tissue 
in  Cavity. — There  is  one  instance  in  the  removal  of  pulps  from 
teeth  where  students  particularly  are  liable  to  make  a  serious  mistake  if 
they  are  not  extremely  careful.  That  is,  in  cases  where,  in  large  oc- 
clusal cavities,  especially  in  lower  first  molars  of  children,  the  pulp 
has  died  and  the  decay  has  extended  through  the  bifurcation  of  the 
roots,  leaving  rough  edges  which  continually  irritate  the  tissue,  caus- 
ing it  to  proliferate  and  ultimately  fill  the  cavity.  To  carelessly  force 
the  anesthetizing  solution  into  such  a  cavity,  where  the  pulp  in  the 
canals  is  putrescent,  would  be  the  means  of  causing  an  acute  alveolar 
abscess.  The  application  of  arsenic  trioxid  would  mean  the  loss  of 
at  least  one  tooth,  perhaps  one  or  two  on  either  side  of  the  one  to 
which  the  application  was  made,  with  a  portion  of  the  alveolar 
process. 

Before  applying  either  the  anesthetizing  or  devitalizing  agent,  a 
correct  diagnosis  should  be  made;  we  should  ascertain  definitely  the 
kind  of  tissue  in  the  cavity.  With  a  little  experience  this  is  usually  a 
simple  matter.  The  history  of  the  case  as  related  by  the  patient  will 
often  serve  as  a  guide.  Pulp  tissue  is  generally  more  sensitive  than  gum 
tissue,  and  when  slightly  pricked  with  a  sharp  instrument  bleeds 
more  profusely.  If  the  tissue  proves  to  be  hypertrophied  gum  tissue 
it  can  be  disposed  of  in  the  usual  manner,  the  puncture  closed  tem- 
porarily with  cement  or  gutta-percha  and  the  tooth  treated  as  the  con- 
dition necessitates.  When  this  cannot  be  accomplished,  it  is  neces- 
sary to  extract  the  tooth. 
19 


290  PRACTICAL    DENTAL    THERAPEUTICS. 

Hypertrophied  Pulp  Tissue. — In  cases  where  the  tissue  is  hy- 
pertrophied  pulp  tissue,  it  will  generally  be  found  unusually  resistant 
to  both  cocain  hydrochlorid  and  arsenic  trioxid,  and  it  is  sometimes 
necessary  to  resort  to  actual  cautery  by  employing  strong  escharotics 
or  to  the  administration  of  such  general  anesthetics  as  nitrous  oxid 
in  order  to  painlessly  remove  the  tissue. 

Secondary  Dentin,  Pulp  Nodules,  and  Pulp  Calcification. — 
Quite  frequently  we  find  cases  where  it  seems  almost  impossible 
to  force  the  anesthetizing  solution  through  the  dentin  and  into  the 
pulp,  and  when  arsenic  troxid  is  applied  it  has  little  or  no  effect.  In 
these  cases  we  can  suspect  that  the  pulp  has  receded  because  of  some 
slight  but  continued  external  irritation  and  the  space  filled  in  with  sec- 
ondary dentin,  the  tubuli  of  which  are  irregular  and  do  not  run  at 
right  angles  to  the  base  upon  which  they  rest,  as  in  the  normal  dentin. 
This  condition  is  more  often  found  in  elderly  patients.  As  a  result 
also  of  external  irritation,  pulp  nodules  and  pulp  calcification  are 
sometimes  encountered.  Many  times  in  removing  the  pulp  in  these 
cases,  the  most  painless  and  best  results  are  obtained  only  by  a  com- 
bination of  both  the  anesthetization  and  devitalization  methods;  for 
the  removal  of  these  pulp  nodules  and  calcified  pulps  is  often  a 
difficult  procedure.  After  we  have  used  cocain  hydrochlorid  and 
pressure  or  previously  applied  arsenic  trioxid  and  anesthetized  or 
devitalized  a  portion  of  the  pulp,  we  may  be  able  to  reach  the  pulp 
nodule  or  nodules  without  producing  pain.  But  frequently  these 
calcific  bodies  are  agglutinated,  and  close  the  mouth  of  the  canal; 
especially  is  this  condition  found  in  molar  teeth.  The  pulp  tissue 
immediately  under  the  nodule  is  extremely  sensitive.  In  such  a  case 
the  anesthetizing  solution  could  not  be  forced  into  the  canal  without 
first  removing  the  obstruction,  and  arsenic  trioxid,  if  applied,  would 
have  no  effect.  These  are  cases  which  require  much  perseverance  and 
patience  on  the  part  of  both  patient  and  operator.  The  nodule  can 
sometimes  be  loosened  by  gently  working  around  it  with  an  exploring 
or  other  suitable  instrument.  The  author  has  met  with  success  by 
taking  a  small  round  bur  and  drilling  past  the  nodule,  care  being  taken 
not  to  puncture  the  root,  then  with  the  engine  running  rapidly  the 
nodule  is  tapped  and  dislodged.  When  the  obstruction  in  the  pulp 
chamber  and  canals  is  removed  the  remaining  tissue  can  be  anesthe- 
tized or  devitalized  in  the  usual  manner.  If  the  devitalization  method 
is  employed,  the  arsenical  preparation  can  be  placed  over  the  mouth 
of  the  canal  with  safety;  but  it  is  never  advisable  to  place  the  preparation 
down  in  the  canal.     In  extreme  cases  it  may  be  necessary  to  inject 


REMOVAL   OF   PULPS   IN    DECIDUOUS.  29 1 

local  anesthetics  into  the  gum  and  pericemental  membrane,  and  thus 
anesthetize  the  pulps,  or  nitrous  oxid  and  oxygen  may  be  administered. 


REMOVAL  OF  PULPS  IN  DECIDUOUS. 

There  is  perhaps  no  dentist  who  has  been  in  practice  for  any 
length  of  time  but  who  has  been  called  upon  to  remove  an  exposed 
pulp  from  a  deciduous  tooth.  With  the  so-called  "horrors  of  the 
dental  chair"  magnified  in  the  child's  mind,  as  is  too  generally  the 
case,  this  is  not  often  the  most  pleasant  thing  the  dentist  is  called 
upon  to  do.  The  question  resolves  itself  largely  into  the  proper 
handling  of  the  child.  Any  expedient  may  be  employed  to  gain  the 
confidence  of  the  little  patient,  after  which  either  the  anesthetization 
or  devitalization  may  be  used  as  deemed  best  under  the  conditions. 
Generally  the  latter  method  is  preferable;  and  it  will  be  found  that 
the  pulps  are  peculiarly  susceptible  to  the  action  of  arsenic  trioxid. 
The  preparation  should  not  be  left  in  the  tooth  longer  than  from 
sixteen  to  twenty-four  hours.  After  the  pulp  is  removed,  all  that 
is  necessary  to  fill  the  root  is  to  flood  with  eucapercha  compound, 
and  fill  the  entire  cavity  with  gutta-percha.  It  is  supposed  by  some 
dentists  that  resorption  of  the  roots  does  not  take  place  when  the 
pulp  is  destroyed.  This  supposition  is  wrong.  It  may  not  be  resorbed 
as  readily  as  though  the  pulps  were  alive,  but  that  resorption  does 
take  place  has  been  clinically  demonstrated  in  the  author's  practice. 

ARSENICAL  POISONING. 

It  may  be  well  to  re-consider  here  the  treatment  of  local  poison- 
ing by  arsenic  trioxid.  However,  when  such  treatment  is  necessary, 
it  is  due  to  carelessness  on  the  part  of  the  dentist  or  the  patient,  or 
both.  It  is  never  necessary  to  tell  the  patient  what  drug  or  remedy 
has  been  used  in  the  treatment  of  teeth,  many  times  it  is  advisable 
not  to  do  so;  but  whenever  an  agent  as  destructive  as  arsenic  trioxid  is 
sealed  within  a  tooth,  the  patient  should  be  thoroughly  impressed  with 
the  importance  of  keeping  an  appointment,  and  of  returning  before 
the  appointed  time  should  any  untoward  symptoms  develop.  The 
patient  should  also  be  informed  that  the  teeth  thus  treated  might 
ache  for  a  few  hours,  as  they  sometimes  do,  even  when  cocain  is  a 
constituent  of  the  arsenical  preparation;  but  that  the  aching  will  be 
of  short  duration.  In  case,  however,  the  tooth  or  gum  becomes  sore, 
they  should  be  instructed  to  return  at  once. 


292  PRACTICAL    DENTAL    THERAPEUTICS. 

In  those  cases  where  the  arsenical  preparation  is  not  hermetically 
sealed  within  the  tooth  and  some  of  it  gets  on  the  gum  tissue,  remain- 
ing only  long  enough  to  cause  devitalization,  all  that  is  necessary  is  to 
first  wash  the  part  with  an  antiseptic  solution,  and  then  mechanically 
pick  off  the  dead  or  sloughed  tissue  with  sterile  pliers  until  bleeding  is 
produced,  if  this  is  possible,  after  which  the  part  should  be  disinfected 
and  the  tissue  stimulated.  To  disinfect  the  part,  any  good  disin- 
fectant can  be  used.  Nothing  is  better  here  than  the  official  3  per 
cent,  solution  of  hydrogen  dioxid.  As  a  means  of  stimulating  the  cells, 
iodin  compounds  are  useful.  The  official  compound  solution  of 
iodin  (5  per  cent.)  can  be  applied  by  first  drying  the  part.  After 
removing  the  dead  tissue  and  disinfecting,  the  author  prefers  applying 
the  euroform  paste  on  cotton  or  gauze.  A  prescription  should  also 
be  written  for  an  antiseptic  mouth-wash  with  which  the  patient  should 
keep  the  mouth  as  clean  as  possible.  The  treatment  can  be  repeated  as 
often  as  the  case  necessitates;  usually  one  or  two  treatments  will  suffice. 

In  those  severe  cases  where  the  arsenic  trioxid  has  penetrated  to, 
and  devitalized  the  process  as  well  as  the  gum,  the  first  treatment  is 
surgical.  After  washing  with  an  antiseptic  solution,  the  affected  proc- 
ess should  be  removed  with  a  suitable  bur  in  the  engine.  It  may  be 
necessary  in  extensive  cases  to  extract  the  tooth,  after  which  the  treat- 
ment is  practically  the  same  as  has  been  outlined  above.  Sometimes 
there  is  pain  following  the  surgical  removal  of  the  affected  process. 
In  this  case  the  euroform  paste  is  especially  indicated;  the  orthoform 
controls  the  pain,  the  europhen  disinfects  and  stimulates,  and  the 
liquid  petroleum  keeps  the  saliva,  laden  with  bacteria,  out  of  the  wound. 
The  case  should  be  watched  closely  and  the  stimulating  treatment 
kept  up  until  the  part  has  healed.  The  tissue  in  the  interproximal 
space  will  never  be  fully  reproduced,  and  will  always  be  a  source  of 
more  or  less  annoyance. 

It  will  be  noted  that  in  discussing  the  treatment  of  local  arsenical 
poisoning,  no  mention  has  been  made  of  dialysed  iron.  The  practice 
of  applying  this  agent  to  the  affected  part  is  both  useless  and  wrong. 

In  conclusion,  the  author  desires  to  emphasize  what  was  stated 
in  the  beginning,  that  it  is  the  plain  duty  of  every  practitioner  to  save 
the  pulps  of  teeth  in  all  cases  where  it  can  be  done  with  any  reasonable 
degree  of  success;  yet  experience  and  observation  will  soon  show  the 
folly  of  attempting  to  save  a  pulp  that  has  been  irritated  for  any  great 
length  of  time,  and  will  prove  also  that  in  these  cases,  the  safest  prac- 
tice is  to  remove  the  pulp  and  subsequently  fill  the  canals,  notwithstand- 
ing the  difficulty  often  attending  the  performance  of  this  operation. 


\<  )XSEPTIC  PERICEMENTITIS. 
GENERAL  CONSIDERATIONS. 

It  is  not  the  intention  to  introduce  in  these  pages  needless  patho- 
logic facts,  yet  in  the  treatment  of  pericementitis  it  is  important  to 
remember  that  the  pericemental  membrane  is  very  vascular  and  well 
supplied  with  nerves;  that  it  is  enclosed  within  bony  walls,  and,  there- 
fore, when  inflammation  exists  in  the  tissue  the  membrane  becomes 
thickened,  forcing  the  tooth  from  its  socket.  This  elongation  of  the 
affected  tooth  is  one  of  the  chief  symptoms  of  true  pericementitis. 

Before  discussing  the  therapeutics  of  this  condition,  I  desire  to 
indelibly  impress  upon  the  mind  of  the  reader  the  fact  that  this  con- 
dition is  too  frequently  produced  by  carelessness  on  the  part  of  dentists. 
It  is  not  always  possible  to  successfully  perform  dental  operations 
without  irritating  the  susceptible  pericemental  membrane;  however, 
much  of  the  trouble  can  be  avoided  if  judgment  is  exercised  and  proper 
precautions  are  taken  in  treating  teeth. 

It  is  important  that  we  differentiate  here  between  nonseptic  and 
septic  pericementitis.  Both  are  inflammatory  conditions  of  the  peri- 
cemental membrane,  the  difference  being  due  largely  to  the  exciting 
agents  causing  the  pathologic  condition.  Septic  pericementitis  is 
produced  by  pathogenic  bacteria,  poisonous  ptomains,  and  irritating 
gases  which  have  escaped  from  putrescent  or  septic  root-canals,  the 
therapeutics  of  which  will  be  discussed  later. 

There  are  at  least  two  classes  of  irritants  by  which  nonseptic 
pericementitis  is  produced,  viz. : 

i.  Drug  irritants. 

2.  Mechanical  irritants. 

Drug  Irritants. — There  are  many  circumstances  and  conditions 
which  influence  the  action  of  drugs  upon  different  individuals  and 
upon  the  same  individual  under  different  conditions.  We  find  cases 
occasionally  where  pulps  have  been  removed  by  pressure  anesthesia, 
and  where,  seemingly  at  least,  every  precaution  was  taken  in  sterilizing 
the  dentin,  selecting  a  sterile  anesthetizing  solution,  and  in  applying  the 
pressure,  yet  severe  apical  pericementitis  follows.  This  may  or  may 
not  be  due  to  the  drugs  used  in  performing  the  operation.     There  are 

293 


294  PRACTICAL   DENTAL   THERAPEUTICS. 

cases,  too,  where  the  pericemental  membrane  becomes  highly  in- 
flamed and  extremely  responsive  from  the  action  of  arsenic  trioxid, 
even  when  the  drug  was  properly  sealed  within  the  tooth  only  a  short 
time.  These  are  conditions  over  which  the  operator  seems  to  have  no 
control;  however,  drugs  are  often  used  injudiciously.  It  has  been 
stated  elsewhere  that  an  anodyne  treatment  was  indicated  after 
the  mechanical  or  surgical  removal  of  the  pulp.  Therefore,  care  should 
be  taken  to  select  drugs  for  this  purpose  which  produce  a  soothing  and 
not  an  irritating  effect.  There  are  some  instances  in  dental  practice 
where  we  desire  to  irritate  and  thereby  stimulate  the  pericemental 
membrane;  but  this  should  be  avoided  here.  Judgment  should  also  be 
exercised  in  sealing  in  anodyne  remedies,  such  as  phenol,  oil  of  cloves, 
etc.,  in  the  canals,  especially  in  bicuspid  and  molar  teeth,  for  should 
the  temporary  filling  be  left  too  full  and  the  remedy  forced  through  the 
apex  by  the  closing  of  the  jaws,  even  these  agents  cease  to  be  anodynes 
and  become  irritants.  Whether  phenol,  oil  of  cloves,  and  similar 
drugs  or  remedies  are  anodynes  or  irritants,  depends  largely,  then,  on 
where  and  how  they  are  used. 

In  filling  root-canals  it  is  the  practice  of  many  dentists  to  moisten 
the  canals  with  eucalyptol  before  introducing  chloropercha  and  the 
gutta-percha  cone.  Care  must  be  taken  here  to  use  eucalyptol  and  not 
oil  of  eucalyptus,  unless  it  be  the  refined  product.  Commercial  oil  of 
eucalyptus  has  been  the  cause  of  many  cases  of  apical  pericementitis 
following  the  most  careful  filling  of  root-canals.  The  eucalyptus  tree 
produces  a  volatile  oil  which  contains  three  constituents,  each  distilling 
over  at  different  temperatures;  the  first  product  thus  obtained  is  eucalyp- 
tol, hence  the  most  volatile  constituent  of  oil  of  eucalyptus  and  the  one 
which  is  the  solvent  for  gutta-percha.  While  eucalyptol  is  a  slight 
irritant,  it  is  not  nearly  so  irritating  as  oil  of  eucalyptus.  The  irritating 
property  of  eucalyptol  can  be  modified  and  its  antiseptic  value  in- 
creased by  adding  menthol  and  thymol  in  the  following  proportion: 

1^ — Mentholis,  gr.  ij  (0.13  gm.) 

Thymolis,  gr.  iij  (0.18  gm.) 

Eucalyptolis,  f5j  (4.0  c.c.) — M. 
Sig. — Use  as  directed. 

This  remedy  is  equally  as  good  a  solvent  for  gutta-percha  as  is  eucalyp- 
tol alone,  and  will  be  called  eucalyptol  compound  in  the  following  pages. 
Some  drugs  when  internally  administered,  notably  mercury  and 
its  compounds,  are  capable  of  producing  nonseptic  pericementitis. 
This  has  been  previously  mentioned  under  Mercurial  Stomatitis. 


NONS]  I'l  l<     i'i  Kiel  Ml  NfTITIS.  295 

Mechanical  Irritants.  The  pericemental  membrane  is  fre- 
quently, 1  might  add  too  frequently,  irritated  by  mechanical  irritant.-. 
such  as  root-canal  fillings,  ill-fitting  partial  plates,  crowns,  and  brid 
malleting,  regulating,  faulty  exclusion,  salivary  and  serumal  calculus, 
etc.  There  is  perhaps  more  pericementitis  produced  by  root-canal 
fillings  than  By  any  other  mechanical  irritant.  In  filling  root-canal-  we 
should  be  absolutely  certain  that  the  canal  is  aseptic.  U  there  be  any 
doubt  as  to  this,  the  operation  should  be  deferred.  The  technic  of 
filling  root-canals  will  be  discussed  later;  however,  it  is  well  to 
mention  here  that  care  should  be  taken  in  filling  all  large  canals  so  that 
the  filling  material  may  not  be  forced  through  the  apex  of  the  root; 
especially  should  we  be  careful  in  tilling  the  canals  of  teeth  after  having 
treated  an  alveolar  abscess.  In  these  cases  we  must  not  expect  the 
patient  to  llinch  in  filling  the  root,  for  there  is  no  live  tissue  at  the  im- 
mediate end.  The  apex  has  been  enlarged  and  it  is  very  easy  to  force 
the  filling  material  through  into  the  space  where  the  tissue  has  been 
destroyed.  When  granulation  fills  this  space  and  the  newly  formed 
tissue  comes  in  contact  with  the  foreign  material  the  result  is  likely  to 
be  a  "lame  tooth,"  which  means  pericemental  trouble  (see  Fig.  5, 
P-  3X4). 

THERAPEUTICS. 

The  first  step  in  the  treatment  of  nonseptic  pericementitis  is  to 
adopt  the  surgical  principle  of  ascertaining  the  cause  and  removing  or 
correcting  it,  if  at  all  possible.  In  the  earlier  stages  of  pericemental 
inflammation,  it  is  not  always  an  easy  matter  to  ascertain  the  true 
cause  of  the  disturbance.  For  instance,  in  those  cases  following  the 
removal  of  the  pulp  tissue,  it  is  difficult  to  know  whether  the  cause  is 
the  root  filling,  the  medicine  used  in  the  treatment,  or  whether  we  failed 
to  establish  and  maintain  asepsis  in  performing  the  operation.  The 
author  is  inclined  to  believe  that  it  is  more  frequently  the  latter  than 
most  operators  are  willing  to  admit;  for  certain  it  is  that  the  more  nearly 
we  approach  absolute  asepsis  in  these  operations,  the  less  pericemental 
trouble  we  will  have.  The  teeth  thus  affected  are  extremely  sore,  and 
any  remedy  can  be  used  in  the  treatment  that  will  give  immediate  re- 
lief. This  is  what  the  patient  most  desires,  and,  too  often  it  appears, 
it  is  that  which  the  dentist  fails  to  give.  Both  local  and  general 
remedies  can  be  employed.  General  remedies  are  more  valuable  in  the 
treatment  of  septic  pericementitis.  If  they  are  used  at  all  in  treating 
nonseptic  pericementitis,  they  should  be  used  only  in  cases  where  the 


296  PRACTICAL   DENTAL   THERAPEUTICS. 

patient  is  nervous  and  has  lost  considerable  sleep.  For  immediate  re- 
lief we  must  depend  largely  upon  the  local  application  of  drugs  and 
remedies.  In  those  cases  following  the  removal  of  the  pulp  by  either 
the  anesthetization  or  devitalization  method,  and  where  the  canals  have 
not  been  filled,  the  pain  can  be  relieved  almost  instantly  by  the  follow- 
ing method:  Adjust  the  rubber  dam.  If  it  is  necessary  to  use  a  clamp, 
it  should  be  placed  on  the  tooth  posterior  to  the  one  affected.  Sterilize 
the  teeth  included  in  the  dam  and  remove  the  dressing  from  the  canals. 
Dehydrate  the  tooth-structure  with  absolute  alcohol.  Then  wrap 
cotton  loosely  around  a  smooth,  sterile  broach,  dip  in  oil  of  cloves  or 
eugenol,  and  carefully  work  in  each  canal.  Remove  the  broach, 
leaving  the  cotton.  Heat  should  now  be  applied  to  the  remedy  by 
means  of  a  hot-air  instrument  or  a  chip-blower  until  the  cotton  becomes 
dry.  Repeat  this  process  several  times,  after  which  the  same  remedy 
should  be  carefully  sealed  within  the  canal.  In  doing  this,  we  not  only 
get  the  benefit  of  the  heat,  which  is  valuable,  but  the  eugenol,  the  con- 
stituent of  cloves,  is  driven  into  the  tooth  structure,  producing  a  pro- 
found anodyne  effect  upon  the  sensitive  membrane.  The  author  has 
succeeded  in  giving  immediate  relief  by  this  method  of  treatment  when 
many  others  have  failed.  Grinding  the  cusps  of  the  tooth  where  it  can 
be  done  without  injury  is  advisable;  a  counterirritant  can  be  applied  to 
the  gum  and  the  patient  dismissed  for  several  days.  It  is  scarcely 
necessary  to  instruct  the  patient  to  favor  the  tooth. 

In  the  treatment  of  pericementitis  following  the  filling  of  the  root, 
having  every  reason  for  believing  that  the  canals  were  aseptic,  one  of 
the  last  things  the  author  would  suggest  doing  would  be  to  attempt  to 
remove  the  root  filling.  Usually  this  only  serves  to  further  aggravate 
the  condition.  These  cases  can  best  be  treated  by  counterirritation 
and  general  remedies.  By  counterirritation  is  meant  the  application  of 
an  irritant  to  some  normal  part  of  the  body  for  the  purpose  of  influenc- 
ing favorably  some  other  part,  usually  deep-seated,  which  is  diseased. 
This  irritant  is  generally  applied  to  the  gum  over  the  affected  tooth. 
Capsicum  plasters,  black  mustard  papers,  cantharidal  collodion,  all 
official  preparations,  are  valuable;  or  the  following  liniments,  which 
are  more  generally  used,  give  much  relief: 

1$ — Mentholis,  .  gr.  xx  (1.3  gm.) 

Chloroformi,  foj  ss  (6.0  c.c.) 

Tincturas  aconiti,  q.  s.  ad.     f5j  (30.0  c.c.) — M. 

Sig. — Dry  the  gum  and  apply  freely  over  the  affected  tooth,  keep- 
ing the  field  dry  for  a  few  seconds. 


NONSEPTIC    PERICEMENTITIS.  297 

T$ — Mcntholis, 

Iodi  (crys.),  ^     gr.  x  (0.6  gm.) 

Chloroformi,  fojss  (6.0  c.c.) 

Tincturae  aconili,  q.  3.  ad.     f5j  (30.oc,c.)-M. 

Sig. — Make  one  application  to  the  dry  gum  as  above. 

1^ — Liquoris  iodi  compositae,  foj  (30.0  c.c). 

Sig. — Use  as  above. 

Inasmuch  as  tincture  of  aconite  is  an  important  ingredient  in 
many  liniments  used  in  the  local  treatment  of  pericementitis  and  facial 
neuralgia,  it  is  well  to  remember  that  the  United  States  Pharmacopeia 
of  1900  reduced  the  strength  of  this  preparation  from  35  per  cent,  to 
10  per  cent.  Therefore  the  new  tincture  can  be  employed  more  freely 
in  these  cases  without  danger  of  poisoning. 

As  a  remedy  to  be  applied  by  the  patient  at  home,  a  split  raisin, 
soaked  in  hot  water,  and  on  which  is  dusted  red  pepper,  can  be  held 
on  the  gum  over  the  affected  tooth.  A  very  efficacious  remedy  is  to 
direct  hot  water  with  some  force  on  the  part,  beginning  with  warm 
water  and  increasing  the  heat  gradually  until  it  is  nearly  boiling.  This 
must  be  kept  up  until  we  get  the  full  benefit  of  the  heat  and  resolution 
promoted.  Another  good  remedy  to  have  the  patient  employ,  is  the 
hot  foot-bath.  The  value  of  this  remedy,  like  the  application  of  hot 
water  to  the  gums,  depends  largely  upon  the  manner  in  which  it  is 
done.  A  deep  foot-bath  tub  should  be  used  and  the  temperature  of 
the  water  gradually  increased  until  it  is  as  hot  as  can  be  borne.  This 
should  be  continued  from  twenty  to  thirty  minutes. 

There  are  many  other  drugs  and  remedies  which  can  be  employed 
in  the  local  treatment  of  this  condition.  Those  which  have  been  mem- 
tioned  here  the  author  has  found  valuable  in  his  practice.  It  is  far 
better  to  have  a  practical  knowledge  of  a  few  remedies  than  a  super- 
ficial knowledge  of  many.  The  general  remedies  to  be  administered 
in  the  treatment  of  nonseptic  pericementitis,  if  found  necessary, 
will  be  discussed  subsequently  under  the  treatment  of  septic  perice- 
mentitis and  incipient  abscess,  which  conditions  are  closely  related. 


PUTRESCENT  PULPS. 
GENERAL  CONSIDERATIONS. 

The  treatment  of  putrescent  pulps  and  their  sequela?  in  the  past 
has,  to  a  great  extent,  been  purely  empirical.  The  reason  for  this 
can  be  found  in  the  apparent  lack  of  interest  which  generally  has 
been  shown  in  the  chemistry  of  pulp  decomposition.  A  knowledge 
of  the  changes  wrought  in  the  splitting  up  of  the  complex  bodies  of  the 
dental  pulp  by  microorganisms  is  of  vital  interest  to  every  practising 
dentist;  and  every  student  should  therefore  familiarize  himself  with 
this  important  subject.1  The  only  method  by  which  drugs  and 
remedies  can  be  scientifically  applied  to  the  treatment  of  the  condi- 
tion under  consideration  is  to  have  a  definite  knowledge  of  the  inter- 
mediate and  end-products  resulting  from  the  putrefactive  process. 

Every  practitioner  of  dentistry  knew  from  sad  past  experience 
that  in  the  process  of  pulp  decomposition  some  kind  of  mephitic  gases 
were  evolved  which,  if  confined,  would  produce  severe  pathologic  disturb- 
ances; but  just  what  the  gases  were  and  how  the  unfavorable  condi- 
tions were  brought  about  we  were  left  to  conjecture.  From  our  study 
of  the  chem'stry  of  pulp  decomposition  we  have  every  reason  for 
believing  that  the  main  gases  produced  are  ammonia  and  hydrogen 
sulphid.  When  these  gases  are  generated  and  cannot  readily  escape 
through  a  cavity,  pressure  is  produced,  thereby  forcing  the  infectious 
material  through  the  apices  of  the  roots  into  the  surrounding  tissue, 
from  which  infection,  septic  pericementitis,  and  in  many  instances  an 
alveolar  abscess  result. 

Coagulating  Drugs. — There  has  been  much  discussion  in  the 
dental  literature  of  the  past  in  regard  to  the  penetrating  or  non- 
penetrating power  of  coagulating  agents  in  putrescent  root-canals. 
It  is  true,  as  claimed  by  some  authorities,  that  such  drugs  as  phenol, 
creosote,  solutions  of  zinc  chlorid,  etc.,  are  contraindicated  in  the 
treatment  of  putrescent  pulps,  but  not  because  they  possess  the 
coagulating  property;  for  when  the  dental  pulp  is  undergoing  or  has 
undergone  the  process  of  decomposition,  the  proteid  constituents  or 
coagulable  substances  have  lost  their  former  identity,  and  new  com- 

1  The  chemistry  of  pulp  decomposition  has  been  discussed  by  the  author  in  Johnson's 
"Text-book  of  Operative  Dentistry,"  p.  341;  and  in  various  dental  journals. 

298 


PI   I  Kl  mi  \  r    PULPS.  299 

pounds  with    entirely  different    properties    have    been    formed.     In 

selecting  drugs  to  be  used  in  the  treatment  of  tin's  condition,  the 
author  will  therefore  eliminate  the  question  of  coagulation,  and  will 
select  drugs,  which  if  properly  used,  will  unite  chemically  with  the  in- 
termediate and  end  products  of  decomposition,  converting  them  into 
odorless  and  nen-infectious  compounds,  as  well  as  destroy  germ  life. 

Important  Products  of  Pulp  Decomposition. — In  this  connec- 
tion it  should  be  remembered  that  the  putrescent  condition  has  been 
brought  about  through  the  agency  of  microorganisms  by  a  gradual 
analytic  process,  and  among  the  products  formed  which  must  be  con- 
sidered in  the  treatment  are  hydrogen  sulphid,  poisonous  ptomains  and 
ammonia  or  derivatives,  the  latter  gas  being  evolved  from  the  further 
putrefaction  of  the  intermediate  compounds  (ptomains  and  amido 
acids).  It  is  well  to  remember  also  that  fats  or  fatty  acids  are  a 
class  of  end-products  resulting  from  the  putrefaction  of  proteid 
substances. 

The  main  gases  formed,  then,  are  ammonia  and  hydrogen  sulphid. 
Xow  it  will  be  necessary  to  dispose  of  these  gases  in  order  to  hermetic- 
ally seal  the  cavity,  an  object  the  accomplishment  of  which  is  much 
desired  in  the  treatment  of  these  cases;  for  by  so  doing  we  prevent  the 
oral  fluids  from  contaminating  the  medicine  within  the  tooth,  the 
medicine  from  escaping  into  the  patient's  mouth,  and  the  tooth 
from  changing  color  during  the  time  of  treatment. 

Drugs  Indicated. — It  has  been  shown  by  Cassidy  and  others 
that  for mahkh yd  (CH20)  is  a  valuable  therapeutic  agent  if  properly 
used.  This  gas  occurs  in  commerce  in  a  37  per  cent,  aqueous  solu- 
tion, which  solution  is  recognized  by  the  United  States  Pharmacopeia 
of  1900  under  the  name  of  liquor  formaldehyd,  or  formalin.  The  gas 
will  unite  with  ammonia,  producing  urotropin,  a  solid,  as  6CH20  + 
4\H,  =  (CH2)6X4+6H20. 

Formaldehyd  unites  also  with  hydrogen  sulphid,  forming,  in  the 
author's  opinion,  methyl  alcohol,  a  liquid,  and  sulphur,  a  solid,  as 
2CH20+2H2S  =  2CH3OH  +  S2. 

It  is  stated  on  good  authority  that  this  same  gas,  formaldehyd, 
united  with  basic  ptomains,  forming  inodorous  compounds.  By  the 
use  of  formaldehyd,  then,  the  irritating  gases  and  poisonous  liquids 
(largely  ptomains)  can  be  changed  chemically  into  nanirritating  and 
nonpoisonous  liquids  and  solids.  The  official  solution  of  formaldehyd, 
however,  is  too  irritating  for  general  use;  therefore,  inasmuch  as  fats 
result  from  pulp  decomposition  and  are  present  as  such  in  a  putrescent 
root-canal,  the  author  selected  cresol  as  an  agent  with  which  to  dilute 


300  PRACTICAL    DEXTAL    THERAPEUTICS. 

the  official  solution  and  thereby  modify  the  irritating  action  of  form- 
aldehyd. Cresol  is  now  also  recognized  by  the  United  States  Pharma- 
copeia of  1900  under  this  name.  Formerly  the  product  was  com- 
mercially called  tricresol.  This  agent  has  a  tendency  to  darken  when 
exposed  to  light.  It  is  recommended  that  a  clear  solution  be  obtained 
and  then  kept  in  an  amber-colored  bottle. 

Liquor  formaldehyd  can  be  diluted  with  such  other  agents  as 
phenol,  or  creosote,  if,  in  the  latter  instance,  a  small  amount  of  alcohol 
is  added  to  clear  the  solution.  Cresol,  however,  is  recommended  for 
four  principal  reasons: 

1.  It  is  miscible  with  the  liquor  formaldehyd  in  all  proportions, 
thus  making,  without  the  addition  of  alcohol,  a  good  pharmacal  prod- 
uct from  which  formaldehyd  gas  is  constantly  generated. 

2    It  is  a  good  disinfectant,  much  more  powerful  than  phenol. 

3.  It  possesses  an  anodyne  property  which  modifies  the  irritating 
action  of  formaldehyd. 

4.  It  acts  chemically  upon  the  fatty  compounds,  thereby  disposing 
to  advantage  of  these  substances. 

Factors  to  be  Considered. — In  the  successful  treatment  of  the 
conditions  under  consideration,  there  are  three  important  factors 
which  must  be  accomplished: 

1.  Establish  asepsis. 

2.  Prevent  recurring  sepsis. 

3.  Preserve  or  restore  the  color  of  the  tooth. 

THERAPEUTICS. 

In  calling  the  attention  of  the  reader  to  a  method  of  treating  this 
condition,  which  has  proved  very  successful  in  the  author's  practice,  I 
desire  to  emphasize  the  necessity  for  observing  the  details  of  the 
method. 

First  Sitting. — Our  first  duty  here,  as  in  all  treatment  cases,  is  to 
make  a  correct  diagnosis,  after  which  the  rubber  dam  should  be  ad- 
justed in  every  case  where  it  is  possible  to  do  so,  and  all  the  teeth 
included,  sterilized.  For  this  purpose  either  a  10  per  cent,  solution 
of  formaldehyd  to  which  a  small  amount  of  borax  has  been  added,  or 
a  1-500  solution  of  mercury  bichlorid  in  cinnamon  water,  or  a  1-200 
sublamin  solution  can  be  used.  After  using  one  of  these  solutions  the 
teeth  are  bathed  in  alcohol,  when,  with  a  suitable  round  bur,  the  pulp 
chamber  is  freely  opened,  exposing  all  of  the  canals,  but  making  no 
attempt  to  remove  the  contents  therein  at  this  sitting.     Now,  on  a  small 


PI   i  ki  SC]  \  i    rri  PS.  301 

pledget  of  cotton  the  following  remedy  is  placed  In  the  pulp  chamber 
and  over  the  mouth  of  each  canal: 

IJ — Cresolis, 

Liquoris  formaldehydi,  4a  £3j  (4.0  c.c.).-  M 

Sig. — Use  as  directed. 

For  convenience  this  remedy  will  be  called  formocresol.  It  is  al- 
ways best  to  seal  the  cavity  with  a  quick-setting  cement,  for  the  remedy 
should  be  hermetically  sealed  and  pressure  must  be  avoided.  To  prevent 
the  cement  from  Oiling  the  entire  cavity  and  also  to  facilitate  its  subse- 
quent removal,  metallic  or  paper  disks  or  even  cotton  can  be  placed  over 
the  remedy,  filling  most  of  the  cavity,  when  only  a  veneer  of  cement  is 
necessary  to  hermetically  seal  it.  This  dressing  can  remain  until  you 
wish  to  have  the  patient  return  for  a  subsequent  sitting.  The  author 
prefers  to  leave  it  about  two  or  three  days.  However,  it  can  be  safely 
changed  the  following  day,  and  no  harm  follow  if  it  remains  a  week  or 
more. 

Second  Sitting. — At  the  second  sitting,  the  rubber  dam  should 
be  adjusted,  the  teeth  included  sterilized,  and  the  dressing  removed, 
after  which  the  canals  should  be  mechanically  cleaned  with  a  proper 
broach,  exercising  the  same  judgment  here  in  the  selection  of  the 
broach  as  has  been  elsewhere  emphasized.  If  there  be  any  odor  in 
the  canals  characteristic  of  putrescence,  or  if  effervescence  is  produced 
by  testing  with  a  solution  of  hydrogen  dioxid,  the  canals  should  be 
dehydrated  with  alcohol  and  warm  air  as  thoroughly  as  possible,  and 
formocresol  again  placed  on  cotton,  this  time  loosely  in  each  canal, 
and  the  cavity  hermetically  sealed. 

In  those  cases,  where,  at  the  second  sitting,  there  is  no  evidence 
of  putrescence,  which  will  be  found  to  be  the  condition  generally  if 
the  first  treatment  is  properly  employed,  the  original  formula  can  be 
modified  and  used.  It  is  not  necessary  or  advisable,  however,  to  keep 
a  modified  formula  prepared.  It  can  readily  be  made  at  the  time  by 
taking  two  minims  of  formocresol  on  a  clean  glass  slap,  and  adding  to 
this  one  or  two  minims  of  cresol  as  thought  best  by  the  operator  at  the 
time.  This  dressing  should  remain  for  at  least  three  days,  by  which 
time  the  remedy  will  have  sterilized  the  entire  tubular  structure  of  the 
dentin,  thus  establishing  asepsis.  All  that  is  necessary  now  to  prevent 
recurring  sepsis  is  to  thoroughly  fill  the  canals.  This  remedy  will  not 
discolor  tooth  structure,  and  the  fact  that  it  not  only  can  but  should  be 
her  medially  sealed  in  the  cavity  will  prevent  discoloration  by  the  in- 
gress of  the  fluids  of  the  mouth.     In  case  the  color  of  the  tooth  crown 


302  PRACTICAL    DENTAL    THERAPEUTICS. 

was  lost  before  undertaking  the  treatment  and  being  desirous  of  pre- 
serving the  tooth  by  an  inlay  or  filling,  the  color  can  be  restored  by  one  or 
two  applications  of  sodium  dioxid.  The  use  of  this  agent  will  be 
explained  subsequently  under  Bleaching  Teeth. 

COMPLICATIONS. — Occasionally  we  encounter  some  complica- 
tion in  the  treatment  of  putrescent  pulps.  These  will  now  be  con- 
sidered. 

Badly  Decayed  Root. — Formocresol  is  very  destructive  to  the 
soft  tissues  of  the  mouth,  therefore  the  importance  of  always  adjusting 
the  rubber  dam.  If  this  cannot  be  done  on  account  of  a  badly 
decayed  root,  it  is  suggested  that  care  be  taken  in  sealing  the  remedy 
in  the  cavity  at  the  first  sitting,  and,  in  placing  the  cement,  the 
original  outline  of  the  root  can  be  approximated.  After  the  cement 
has  set,  a  band  or  matrix  of  gold  or  German  silver  can  be  fitted  to, 
and  cemented  on  the  root.  In  treating  the  case  where  there  is  a  tooth 
posterior,  it  is  best  to  place  the  clamp  on  this  tooth  and  gently  stretch 
the  rubber  over  the  band  and  thereby  avoid  loosening  it. 

Pulp  Partially  Alive. — In  those  cases  where  the  pulp  tissue 
is  putrescent  in  one  or  more  canals  of  a  multirooted  tooth  and  alive 
in  the  other  one  or  two  canals,  as  the  case  may  be,  we  will  find  much 
satisfaction  in  using  the  formocresol  remedy.  These  are  exceptional 
cases  and  it  is  difficult  to  know  whether  this  condition  exists  until  the 
second  sitting.  If  there  be  much  vitality  in  the  live  pulp  tissue,  the 
formaldehyd  in  the  remedy  will  doubtless  make  the  tooth  ache,  but 
after  we  know  the  conditions  our  method  of  procedure  is  simple,  and 
the  results  will  be  certain.  A  small  pledget  of  cotton  dipped  in  the 
remedy  can  gently  be  placed  over  the  mouths  of  the  canals  which  con- 
tain putrescent  material,  and  a  thin  quick-setting  cement  flowed  over 
the  cotton.  After  the  cement  has  set,  the  live  pulp  tissue  in  the  remain- 
ing canals  can  be  anesthetized  or  devitalized  as  the  operator  deems  best 
at  the  time.  Formerly  these  were  difficult  cases  to  treat,  but  with  a 
remedy  which  can  be  hermetically  sealed  in  a  putrescent  root-canal, 
the  procedure  is  materially  simplified.  Occasionally,  one  may  open  into 
a  single-rooted  tooth,  having  all  the  symptoms  of  a  dead  pulp,  and  find 
a  drop  of  pus  in  the  bulbous  portion  of  the  pulp  with  the  remaining 
portion  still  alive.  Some  writers  call  this  condition  a  septic  pulp  in 
contradistinction  to  true  putrescence  (presence  of  gases).  In  such 
a  case,  any  remedy  containing  formaldehyd  would  cause  the  tooth  to 
ache;  therefore,  in  the  treatment  of  so-called  septic  pulps,  the  pus  can 
be  washed  out  of  the  cavity  with  a  warm  antiseptic  solution,  the  cavity 
dried,  and  asepsis  established  by  hermetically  sealing  in  phenol  com- 


IT  IKIMIM     PI    I  PS.  3O3 

pound,   after  which   the  pulp  can  be  anesthetized  or  devitalized  as 

usual. 

The  author  realizes  that  the  method  of  treating  putrescent  pulps, 
here  given,  is  a  radical  departure  from  those  generally  advocated;  and, 

like  myself,  at  first  sonic  of  my  experienced  readers  may  hesitate  to 
hermetically  seal  a  cavity  in  a  tooth  which  contains  a  putrescent  pulp. 
The  reason  this  could  not  be  done  in  the  past  by  the  methods  in 
vogue  is,  that  drugs,  in  most  instances,  were  selected  and  used  solely 
because  of  their  ability  to  inhibit  the  growth  or  destroy  the  vitality  of 
microorganisms.  The  fact  that  there  were  other  things,  such  as  irri- 
tating gases  and  poisonous  ptomains,  found  in  the  canal  and  tubular 
structure  of  the  dentin,  and  also  the  further  fact  that  it  was  as  necessary 
to  dispose  of  these  substances  as  it  was  to  destroy  germ  life,  was  not 
given  the  significance  this  phase  of  the  subject  merited.  The  treat- 
ment which  is  here  outlined  is  along  rational  lines,  for  the  remedy 
chemically  converts  the  noxious  intermediate  and  end-products  of 
pulp  decomposition  into  substances  which  themselves  possess  anti- 
septic and  disinfectant  properties. 

OTHER  METHODS.— A  method  of  treating  putrescent  pulps  by 
the  use  of  metallic  potassium  and  sodium  was  given  to  the  profession 
by  Schreier,  of  Vienna,  in  1893.  It  consists  in  chemically  neutralizing 
the  intermediate  and  end-products  of  pulp  decomposition,  and  at 
the  same  time  establishing  asepsis  by  using  a  mixture  of  the  metals. 
The  preparation  may  be  obtained  in  a  small  tube,  covered  with 
paraffin,  which  prevents  undue  exposure  to  air  and  moisture.  The 
method  is  favored  by  Rhein  and  others,  and  its  technic  follows: 
With  the  rubber  dam  adjusted  and  every  thing  in  readiness,  a  barbed 
broach  may  be  pushed  through  the  paraffin  covering  and  into  the 
metallic  mass,  and  by  gently  withdrawing  small  particles  adhere,  in 
which  manner  it  may  be  transferred  to  the  putrescent  canal.  A 
violent  reaction  at  once  takes  place,  the  metals  attack  the  water 
molecule,  and  hydroxids  are  formed,  which  in  turn  act  upon  the 
fatty  end-products,  forming  a  soluble  soap  which  can  subsequently 
be  washed  out  of  the  canal,  leaving  it  clean  and  sterile.  If  care  is 
exercised  in  the  technic,  the  entire  contents  of  the  canal  may  be 
chemically  destroyed,  when  the  latter  may  be  dehydrated  with  alcohol, 
an  anodyne  remedy  sealed  in,  and,  at  a  subsequent  sitting,  the  case 
giving  a  favorable  history,  the  canals  can  be  filled. 

Kirk.  Hodgens,  and  others  recommend  sodium  dioxid  for  the 
same  purpose,  and  the  agent  is  used  in  practically  the  same  manner. 
The  chemistry  involved  in  the  treatment  is  similar  to  that  of  Schreier's 


304  PRACTICAL   DENTAL    THERAPEUTICS. 

method,  except,  besides  having  sodium  hydroxid  formed  which  acts 
upon  the  fatty  end-products,  oxygen  in  the  nascent  state  is  liberated, 
which  aids  in  establishing  asepsis  and  at  the  same  time  tends  to  bleach 
the  tooth. 

Neither  of  these  methods' of  treatment  should  be  used  by  careless 
operators.  The  danger  lies  in  forcing  the  putrescent  material  or 
remedy  through  the  apices  of  the  roots,  which  always  results  in  an 
extremely  sore-tooth,  if  not  an  alveolar  abscess. 

The  methods  are  discussed  here  briefly  because  they  are  chemically 
correct  and  are  along  rational  and  scientific  lines.  If  care  and  judg- 
ment is  exercised  in  the  use  of  either  remedy,  good  results  will 
surely  follow. 


SEPTIC   PERICEMENTITIS  AND   ACUTE   ALVEOLAR 

ABSCESS. 

GENERAL  CONSIDERATIONS. 

The  treatment  of  septic  pericementitis  and  acute  alveolar  abscess, 
as  was  intimated  under  Nonseptic  Pericementitis,  is  so  nearly  identical 
that  the  therapeutics  will  be  discussed  here  conjointly.  In  those  cases 
of  putrescent  pulps  where  the  patient  did  not  present  for  treatment 
until  the  confined  gases  had  escaped  through  the  end  of  the  root,  carry- 
ing the  bacteria  and  poisonous  ptomains  into  the  surrounding  tissue, 
it  is  our  duty  to  try  to  aid  Nature  in  aborting  an  abscess.  It  is  in  these 
cases  that  good  judgment  must  be  exercised  and  extreme  care  taken. 
There  is  no  condition  which  we  are  called  upon  to  treat  wherein  a  practi- 
cal knowledge  of  pathology  and  therapeutics  will  serve  us  better  than 
in  this  particular  case.  Frequently  patients  delay  coming  to  the 
dentist  until  the  infection  has  progressed  to  a  point  where  all  remedies 
will  fail  in  aborting  an  abscess;  but  in  many  instances  this  result  may 
be  prevented  by  the  proper  use  of  drugs. 

THERAPEUTICS. 

Local  Treatment. — The  local  treatment  here  is  exactly  the  same 
as  for  an  ordinary  putrescent  pulp;  for  you  never  have  a  case  of 
septic  pericementitis  or  incipient  alveolar  abscess  unless  the  pulp  is 
dead  and  has  undergone,  partially  at  least,  the  process  of  decomposi- 
tion. However,  if  the  tooth  is  extremely  sore,  as  is  usually  the  case,  the 
patient  need  not  be  subjected  at  this  sitting  to  the  annoyance  of  ad- 
justing the  rubber  dam.  Keep  the  tooth  just  as  dry  as  possible,  open 
into  the  pulp  chamber,  holding  the  tooth  by  some  means,  while 
drilling,  so  that  the  jarring  will  not  further  irritate  the  condition; 
then  carefully  seal  in  the  formocresol  remedy  with  cement;  after  which 
our  attention,  if  necessary,  should  be  given  to  the  treatment  of  the 
infected  pericemental  membrane. 

General  Treatment. — In  order  to  control  the  infection,  and  at 
the  same  time  aid  Nature  in  readjusting  the  abnormal  condition,  it 
is  not  only  our  privilege,  but  it  is  our  duty  in  these  severe  cases  to  ad- 
minister internal  drugs.     Here  alterative  drugs  are  indicated.     The 

20  3°5 


306  PRACTICAL   DENTAL   THERAPEUTICS. 

great  representative  of  the  alterative  class  is  potassium  iodid,  which 
can  be  given  in  tiie  following  prescription : 

1$ — Potassii  iodidi,  ojss  (6.0  gm.) 

Syrupi  sarsaparilke  comp.,         foiij  (90.0  c.c). — M. 
Sig. — Take  a  teaspoonful  in  water  after  meals. 

Ordinarily,  the  directions  would  be  as  given,  to  have  the  patient 
take  a  teaspoonful  three  times  a  day  after  meals;  but  in  these  cases  of 
septic  pericementitis  or  incipient  alveolar  abscess  it  is  best  to  direct  the 
patient  to  take  a  teaspoonful  every  two  hours  until  three  or  four  doses 
are  taken,  and  then  follow  the  directions  written  on  the  label.  It  is  well 
also  to  avoid  the  accumulation  of  blood  in  the  part.  To  prevent  this, 
saline  cathartics  are  indicated — one  that  can  be  given  is  the  official 
solution  of  magnesium  citrate,  owing  to  the  facility  with  which  it  can 
be  taken  and  its  acceptability  to  the  stomach,  a  prescription  for  which 
follows : 

1$ — Liquoris  magnesii  citratis,  foxij  (360.0  c.c). 

Sig. — Take  one-half  at  once  and  the  other  half  in  two  (2)  hours,  if 
necessary. 

Magnesium  sulphate  (Epsom  salts)  is  also  an  excellent  remedy  to  be 
used  for  the  latter  purpose.  The  patient  can  be  directed  to  take 
a  teaspoonful  dissolved  in  a  wineglassful  of  warm  water,  having  a  glass 
of  cold  drinking  water  at  hand  to  drink  at  once  after  taking  the  strong 
hyperisotonic  salt  solution.  The  cold  water  removes  at  once  the 
bitter  and  unpleasant  taste  of  the  salt.  A  very  good  remedy  to  have  the 
patient  employ  at  home  is  the  hot  foot-bath.  In  malarial  regions 
and  in  the  spring  of  the  year  in  many  localities,  the  salts  of  quinin  can  be 
given,  with  beneficial  results.  The  salt  which  the  author  prefers  giving, 
if  indicated  in  the  conditions  under  consideration,  is  quinin  bisulphate. 
Nearly  all  pharmacies  have  the  salts  of  quinin  put  up  in  the  form  of 
pills.  While  these  pills  may  be  given,  it  is  much  better  to  write  a 
prescription  for  capsules.  The  gelatin  capsule  is  soon  dissolved  in 
the  stomach;  thus  we  obtain  the  action  of  the  drug  more  rapidly  than 
when  given  in  the  dry,  hard,  pilular  form.  The  following  prescription 
can  be  written  for  the  drug  in  two-grain  doses: 

1$ — Quininse  bisulphatis,  gr.  xxiv  (1.5  gm.). 

Ft.  capsula,  No.  xij. 
Sig. — Take   one   capsule   every   hour    until    the  effect  becomes 
noticeable. 

Quinin  acts  differently  upon  different  individuals.  Most  adult  pa- 
tients know  the  effect  of  this  drug  upon  their  system,  and  therefore 


ACUTE  ALVEOLAR  ABSCESS.  307 

will  be  able  to  aid  the  dentist  in  determining  the  amount  to  be  taken 
in  a  given  case. 

One  of  the  most  prominent  symptoms  with  which  we  have  to 
content  here  is  pain.  In  most  cases  the  pain  will  subside  soon  after 
the  local  treatment;  however,  it  is  necessary  occasionally,  where  the 
patient  is  nervous  and  has  lost  considerable  sleep,  to  administer 
drugs  which  act  upon  the  central  nervous  system,  thereby  controlling 
the  pain.  There  are  several  drugs  which,  if  properly  given,  will  pro- 
duce the  desired  effect.  The  official  compound  powder  of  acetanilid 
is  here  recommended  and  can  be  prescribed  as  follows: 

1^ — Pulveris  acetanilidi  comp.,  gr.  xij  (0.8  gm.). 

Ft.  chartula,  No.  ij. 
Sig. — Take  one  powder  at  once  and  the  other  in  two  (2)hours,  if  not 
relieved. 

Another  very  useful  prescription  for  acetanilid  is  one  suggested   by 
Harlan.    It  follows: 

1^ — Acetanilidi,  gr.  viij  (0.5  gm.) 

Syrupi  simplex,  f5ss  (15.0  c.c.) 

Spiritus  frumenti,  q.  s.  ad.     fsiij  (90.0  c.c.) — M. 

Sig. — Take  one-half  at  once  and  the  remainder  in  two  (2)hours,  if 
not  relieved. 

Keefe,  of  Chicago,  suggests  using  dilute  alcohol  by  which  instan- 
taneous and  often  permanent  relief  can  be  obtained  in  those  cases 
where  the  tooth  involved  is  one  of  the  six  upper  anterior  teeth.  A  pre- 
scription for  the  remedy  is  here  given: 

1$ — Alcoholis, 

Aquae,  aa.  f5j  (30.0  c.c.) — M 

Sig. — Use  as  directed. 

This  remedy  is  best  administered  in  the  form  of  a  spray,  using  a 
watch-case  atomizer  for  liquids,  forcing  the  spray  well  back  into  the 
nostril  on  whichever  side  the  affected  tooth  is  located.  The  applica- 
tion can  be  repeated  as  often  as  is  necessary  without  any  ill  effects.  In 
case  an  atomizer  of  any  kind  is  not  at  hand,  about  fifteen  minims  of 
the  remedy  can  be  placed  far  back  in  the  nostril  with  a  suitable  syringe. 

The  author  does  not  wish  to  be  understood  as  suggesting  these 
various  internal  remedies  in  all  cases  of  acute  abscess.  No  therapeu- 
tist can  tell  exactly  what  internal  drugs  he  would  suggest  without 
seeing  the  case  and  knowing  the  history;  for  there  are  many  circum- 
stances and  conditions  which  modify  the  effect  of  drugs.  Every  rem- 
edy here  mentioned,  however,  will  be  found  useful  in  certain  cases. 


o 


08  PRACTICAL   DENTAL   THERAPEUTICS. 


The  Question  of  Extraction. — The  question  of  extraction  in 
acute  alveolar  abscess  is  a  disputed  one.  Many  writers  recommend  ex- 
traction as  a  speedy  means  of  affording  relief.  Unfortunately,  however, 
this  is  not  always  the  solution  of  the  problem;  for  if  there  be  much 
osteomyelitis  and  the  roots  of  the  offending  tooth  be  firmly  imbedded, 
it  is  a  rather  dangerous  procedure  to  extract  during  the  developmental 
stage  on  account  of  the  liability  of  a  mixed  infection,  resulting  often- 


Fig.  3  shows  a  sequestrum  which  was  exfoliated  from  the  lower  jaw.  This 
result  followed  extensive  infection,  endangering  the  life  of  the  patient,  and  ultimate  necrosis 
from  the  extraction  of  a  lower  second  bicuspid  root,  during  the  acute  stage  of  an  alveolar 
abscess.  A  mixed  infection  doubtless  resulted  from  the  laceration  of  tissues.  It  will 
be  noticed  that  the  sequestrum  contains  the  mental  foramina,  which  means,  of  course,  that 
the  inferior  dental  nerve,  artery,  and  vein  were  severed.  The  lip  on  the  affected  side  was 
partially  paralyzed  for  a  period  of  two  or  three  years;  and,  in  opening  into  the  first  bicuspid 
for  the  purpose  of  pulp  removal  for  bridge-work,  six  months  later  the  pulp  was  dead  and 
just  beginning  to  undergo  the  process  of  decomposition. 

times  in  necrosis  and  frequently  even  threatening  the  life  of  the 
patient  (see  Fig.  3).  If  the  root  be  a  worthless  one  and  easily  ex- 
tracted, its  removal  would  doubtless  afford  free  drainage  for  the 
abscess.  There  is  no  set  rule  governing  extraction  in  these  cases. 
The  operator  must  be  guided  largely  by  the  conditions  as  found. 
When  extraction  is  resorted  to,  antiseptic  mouth-washes  should  be 
prescribed  and  the  case  watched  closely  for  a  few  days  until  we  are 
certain  that  no  complication  will  follow. 


CHRONIC  ALVEOLAR  ABSCESS. 
GENERAL  CONSIDERATIONS. 

There  are  two  varieties  of  chronic  alveolar  abscesses — those 
without  an  external  opening,  except  perhaps  through  a  cavity  in  the 
offending  tooth,  and  those  which  are  discharging  through  a  sinus.  In 
these  cases  the  decomposition  of  the  pulp  tissue  is  complete;  the  inter- 
mediate products  (ptomains  and  amido-acids)  have  largely  been  broken 
up,  and  pus  has  been  formed  from  the  tissue  and  fluids  surrounding  the 
ends  of  the  roots. 

i.  ABSCESS  WITHOUT  SINUS. 

In  treating  that  variety  of  alveolar  abscess  which  is  without  an 
external  opening,  our  method  of  procedure  is  somewhat  different  from 
that  of  an  acute  abscess.  The  tooth  should  be  located;  the  rubber  dam 
adjusted,  and  the  teeth  sterilized  as  before;  then  the  pulp  chamber  is 
opened  with  a  suitable  round  bur. 

Disposing  of  the  Pus. — Usually  the  pus  flows  freely,  in  which 
case  it  is  permitted  to  do  so,  pressure  being  made  on  the  tissue  immedi- 
ately over  the  end  of  the  root.  It  should  be  our  effort  to  mechanically 
evacuate  as  much  pus  at  each  sitting  as  is  possible.  This  being  done, 
we  have  no  necessity  for  using  formaldehyd  in  the  same  strength  solu- 
tion as  in  those  cases  where  the  pulp  chamber,  root-canals,  and  tubuli 
are  filled  with  the  intermediate  and  end-products. 

THERAPEUTICS. 

The  modified  formocresol  remedy  will  be  useful  here.  The 
canals  should  be  dried  with  alcohol  as  thoroughly  as  possible  and 
the  remedy  on  cotton  hermetically  sealed  in  each  canal.  It  is,  how- 
ever, at  this  sitting,  impossible  to  get  the  canals  dry,  and  it  is  unneces- 
sary to  have  them  so,  for  the  remedy  will  penetrate  where  moisture 
is  present.  This  is  an  advantage  over  most  remedies  suggested  for 
this  purpose.  In  those  cases  where  there  is  pain  and  swelling, 
together  with  a  copious  flow  of  pus  which  seemingly  cannot  be  checked 
at  this  time,  it  may  be  necessary  to  evacuate  the  pus  as  completely  as 
possible,  loosely  place  in  the  canal  a  few  shreds  of  cotton  saturated 
with  an  antiseptic  remedy  (phenol  compound),  and  then  place  in  the 

309 


310  PRACTICAL   DENTAL   THERAPEUTICS. 

cavity  a  pledget  of  cotton  dipped  in  liquid  petroleum.  In  no  case 
should  the  cavity  be  left  entirely  open;  and  the  author  desires  to 
emphasize  that  it  is  seldom  necessary  to  resort  to  this  temporary  ex- 
pedient, if  the  proper  time  is  spent  in  opening  into  the  tooth  and 
evacuating  the  pus.  The  dressing,  in  any  event,  should  be  changed 
every  day  until  it  can  be  removed  without  the  pus  flowing  from  the 
canals.  When  pus  is  forming  rapidly  at  the  end  of  the  roots,  the  dress- 
ing soon  becomes  dissipated,  the  remedy  is  neutralized,  and  it  is  a  loss 
of  time  to  leave  it  in  the  canals  more  than  twenty-four  hours.  Unless 
there  be  some  complication,  the  pus  formation  should  be  checked  in 
one  or  two  treatments;  at  which  time  the  modified  formocresol  remedy 
can  again  be  used.  It  is  now  possible  to  change  the  dressing  too  often. 
The  formation  of  pus  has  been  checked,  and  the  tooth  should  not  be 
disturbed  for  at  least  one  week  or  ten  days,  in  order  to  give  Nature  a 
chance  to  effect  a  cure.  If,  at  the  end  of  this  time,  there  is  no  evidence 
of  pus  and  the  case  gives  a  favorable  history,  the  canals  can  be  filled. 
Should  there,  however,  be  a  slight  odor,  although  the  tooth  has  not 
caused  any  trouble,  we  are  not  justified  in  filling  the  root.  In  these 
cases  we  can  further  modify  our  original  formula  by  taking  one  drop  of 
the  mixture  and  adding  two  or  three  drops  of  cresol.  It  should  be 
remembered  that  the  value  of  formaldehyd  in  any  remedy  to  be  used  in 
the  treatment  of  these  conditions  depends  upon  the  power  this  agent  has 
of  uniting  chemically  with  hydrogen  sulphid,  ammonia  and  poisonous 
ptomains.  When  these  substances  are  not  present,  formaldehyd, 
especially  in  this  strength  solution,  is  contraindicated.  This  precau- 
tion is  mentioned  here  because  formaldehyd  is  an  irritating  gas,  and 
any  remedy  containing  it  should  be  modified  according  to  the  conditions 
as  found. 

"Weeping  of  Serum. — Quite  frequently  in  these  alveolar  abscess 
cases,  after  the  formation  of  pus  has  been  checked,  we  have  a  weep- 
ing of  serum  from  the  canals.  An  excellent  remedy  to  use  in  this  case 
is  eucalyptol  to  which  thymol  has  been  added  in  the  following 
proportion: 

1$ — Thymolis,  gr.  x  (0.6  gm.) 

Eucalyptolis,  foj  (4.0  c.c.) — M. 

Sig. — Dry  the  canal  as  much  as  possible  and  hermetically  seal  in 
the  remedy. 

If  this  remedy  fails  to  check  the  secretion  and  the  fluid  is  serum,  not 
pus,  no  hesitancy  need  be  felt  as  to  filling  the  root,  although  the  canals 
cannot  be  dried. 


CHRONIC  ALVEOLAR   ABSCESS.  3II 

Complications. — Occasionally  we  find  a  chronic  alveolar  abscess 
of  this  variety  where  it  is  almost  impossible  to  check  the  formation  of 
pus  by  applying  drugs  to  the  canals  of  the  teeth.  Jn  those  cases 
where  the  pus  continues  to  flow  freely  when  the  dressing  is  removed  at 
the  third  or  fourth  sitting,  some  complication  can  be  expected.  It  is 
necessary  then  to  force  some  stimulating  agent  through  the  apices  of 
the  roots,  after  the  pus  has  been  mechanically  evacuated.  The  stim- 
ulating agent  which  the  author  uses  almost  invariably  is  a  50  percent. 
solution  of  phenolsulphonic  acid.  In  resorting  to  this  means  of  bring 
ing  about  a  more  acute  condition,  I  desire  to  emphasize  the  necessity 
of  first  evacuating  the  pus  as  completely  as  possible  before  using  the 
remedy,  after  which  the  agent  should  be  gently  forced  through  the 
apices  and  the  modified  formocresol  remedy  sealed  in  the  canal.  It 
will  be  found  that  one  or  two  treatments  will  usually  check  the  forma- 
tion of  pus,  after  which  the  case  can  be  treated  as  an  ordinary  abscess 
of  this  kind.  In  case  this  method  fails  to  effect  a  cure,  however,  it 
will  be  necessary  to  surgically  establish  an  opening  through  the  overly- 
ing process  and  soft  tissue  and  treat  as  for  an  ordinary  discharging 
abscess — which  treatment  will  now  be  considered. 


2.  ABSCESS  WITH  SINUS. 

In  those  cases  where  the  pus  is  discharging  into  the  mouth  through 
a  sinus,  our  first  duty  is  to  locate  the  offending  tooth.  This  is  gener- 
ally a  simple  matter  for  the  reason  that  the  sinus  usually  opens  imme- 
diately over  the  tooth  from  which  it  comes.  The  pus  in  making  its 
exit,  however,  follows  the  line  of  least  resistance,  and  in  some  cases  the 
condition  of  the  process  is  such  that  the  pus  burrows  forward  or  back- 
ward, and  opens  through  the  gum  at  a  point  several  teeth  removed 
from  the  one  which  is  causing  the  trouble.  These  are  the  cases  that 
are  difficult  to  diagnose,  especially  where  the  abscess  has  been  discharg- 
ing for  some  time,  when  there  is  not  much  tenderness  in  any  special 
tooth,  and  where  there  are  several  pulpless  teeth  on  this  side  of  the 
mouth.  Sometimes  two  teeth  containing  putrescent  pulps  have  a 
common  sinus.  In  this  case  it  would  be  impossible  to  heal  the  tract 
by  treating  only  one  of  the  teeth.  The  use  of  a  silver  probe  will  be 
valuable  in  all  such  cases.  By  gently  working  the  probe  forward  or 
backward  the  sinus  can  be  explored  and  the  offending  tooth  or  teeth 
located  without  drilling  into  innocent  teeth — a  discouraging  pro- 
cedure to  both  patient  and  dentist. 


312  PRACTICAL    DENTAL    THERAPEUTICS. 

THERAPEUTICS. 

The  tooth  being  located,  all  that  is  necessary  to  effect  a  cure — 
there  being  no  complication — is  to  force  some  bland  solution  through 
the  root- canal  and  sinus,  thus  being  certain  it  is  well  established; 
cauterize  the  tract,  hermetically  seal  in  the  canal  or  canals,  the  same 
agent  used  for  this  latter  purpose  or  the  modified  formocresol  remedy, 
and,  at  the  subsequent  sitting,  the  case  giving  a  favorable  history,  fill 
the  root. 

Establishing  Sinus  and  Disposing  of  Pus. — If  the  abscess  is 
not  discharging,  and  it  is  well  in  those  cases  where  it  is  discharging, 
before  adjusting  the  rubber  dam,  to  enlarge  the  mouth  of  the  sinus 
with  a  lancet  or  bistoury.  By  dipping  the  lancet  in  phenol,  this  may 
be  accomplished  with  very  little  pain  to  the  patient.  After  this  is 
done,  the  rubber  dam  should  be  adjusted  and  the  canals  freely  exposed. 
Now  that  the  infection  is  past  the  end  of  the  root,  we  need  not  hesitate 
to  mechanically  clean  the  canal  at  this  sitting.  The  canals  being  clean, 
we  are  ready  to  establish  the  sinus.  To  do  this  we  need  a  bland  solu- 
tion and  a  good  hypodermic  syringe  with  a  long  straight  needle  for 
anterior  and  a  long  curved  needle  for  posterior  teeth.  There  is  an 
advantage  in  having  a  long  needle,  for  the  nearer  the  point  is  to  the 
apex  of  the  root,  the  less  packing  and  force  is  required  to  send  the  solu- 
tion through  the  sinus.  Any  bland  solution  can  be  used  for  this  pur- 
pose. The  author  suggests  peppermint  water  to  which  two  minims  of 
phenol  has  been  added  to  the  fluidounce.  A  piece  of  unvulcanized  rub- 
ber of  the  proper  size  should  be  selected,  softened  in  the  flame,  and  a 
hole  made  in  the  center  through  which  the  needle  is  placed  and  inserted 
into  the  canal.  The  rubber  should  now  be  tightly  packed  around 
the  needle  and  held  on  either  side  with  flat-nose  pliers,  when  pressure 
can  be  made  on  the  piston  of  the  syringe  and  the  solution  forced  through 
the  sinus.  This  should  be  repeated  several  times,  care  being  taken 
not  to  break  the  needle  in  the  canal.  If  convenient,  one  corner  of  the 
dam  can  be  raised,  exposing  the  mouth  of  the  sinus  to  view.  There 
are  two  objects  in  forcing  a  bland  solution  through  the  sinus:  one 
is  to  be  certain  that  it  is  open,  and  the  other  is  to  mechanically  wash 
out  the  pus.  Whenever  pus  can  be  mechanically  removed,  it  is  al- 
ways better  to  dispose  of  it  by  this  means  rather  than  to  do  so  by  the 
use  of  some  chemic  agent.  It  is  common  practice  after  the  sinus  is 
established  to  use  a  solution  of  hydrogen  dioxid.  This  is  often  a 
dangerous  procedure  and  always  unnecessary  if  the  first  solution  has 
been  used  in  sufficient  quantity. 


(   I  IRONIC   ALVEOLAR   ABSCESS.  313 

Cauterizing  Sinus.  For  cauterizing  the  sinus  in  simple  cases 
95  per  cent,  phenol  has  been  largely  employed.  An  excellent  prepa- 
ration to  use  for  this  purpose  is  the  phenol  compound  remedy.  With 
the  sinus  well  established,  it  is  never  necessary  to  place  either  of 
these  solutions  in  a  hypodermic  syringe.  The  author  knows  of 
several  instances  where  this  has  been  tried  with  disastrous  results. 
The  remedy  can  be  applied  to  the  canals  on  cotton,  when,  with  unvul- 
canized  rubber  and  a  suitable  instrument,  it  can  be  forced  through 
the  sinus.  Alcohol  is  a  positive  antidote  for  phenol;  the  alcohol 
bottle  should  therefore  be  in  a  convenient  place  so  that  the  remedy  used 
in  the  canal  can  be  neutralized  at  once  when  it  appears  at  the  mouth 
of  the  sinus.  If  this  has  been  well  done,  it  matters  little  what  drug 
or  remedy  is  sealed  in  the  canal.  The  phenol  compound  remedy  or 
the  modified  formocresol  solution  will  give  excellent  results  if  hermeti- 
cally sealed  in  the  canals  for  about  one  week. 

In  cases  of  long  standing  when  we  can  reasonably  suspect  a  rough- 
ening of  the  end  of  the  root  or  process  through  which  the  pus  has  been 
discharging,  it  is  good  practice  to  use,  as  the  cauterizing  agent,  50 
per  cent,  solution  of  phenolsulphonic  acid,  and  in  stubborn  cases  the 
pure  acid  can  be  employed.  This  agent  rapidly  disintegrates  cotton, 
therefore  it  can  be  placed  in  the  canal  on  threads  of  asbestos,  wool  fiber, 
or  silk,  and  forced  through  the  sinus  in  the  usual  manner,  cauterizing  it, 
and  also  stimulating  the  sluggish  cells  in  the  area  to  healthy  activity. 

It  is  sometimes  difficult  to  established  the  sinus,  especially 
on  molar  teeth.  In  all  such  cases  where  there  is  no  complication, 
the  case  can  be  nicely  treated  with  formocresol  solution  as  outlined 
under  Treatment  of  Abscess  Without  Sinus. 

The  author  does  not  believe  in  delaying  the  root  filling  long  after 
the  sinus  has  been  cauterized  in  uncomplicated  cases,  for  by  filling 
the  root  as  soon  as  we  are  certain  that  the  sinus  is  healing,  we  avoid  a 
weeping  condition,  which  usually  exists  and  which  is  annoying  when 
this  part  of  the  treatment  is  delayed  for  one  month  or  six  weeks  as 
advocated  by  some  writers.  In  these  cases  where  the  first  treatment 
has  been  thorough,  and  the  case  gives  a  favorable  history,  the  root 
should  be  filled  at  the  second  or,  at  most,  at  the  third  sitting.  If  the 
case  does  not  yield  to  the  above  treatment,  some  complication  may 
be  expected. 

COMPLICATIONS. 

There  are  several  complications  of  chronic  alveolar  abscess  of 
both  varieties,  with  and  without  a  sinus,  where  it  is  necessary  to  modify 


|I4 


PRACTICAL    DENTAL    THERAPEUTICS. 


or  change  the  general  method  of  treatment  to  meet  the  conditions 
as  they  exist.  For  instance,  in  the  case  of  an  abscess  without  a 
sinus  where  we  can  reasonably  suspect,  and  where  the  indications 
point  to,  a  roughening  of  the  end  of  the  root,  we  ought  not  to  ex- 
pect to  cure  the  case  by  simply  sealing  remedies  within  the  canals  of  the 
tooth.  If  we  do,  we  are  expecting  too  much  of  drugs.  Again,  in  a  case 
of  an  abscess  with  a  sinus  where  the  pus  has  been  discharging  for  several 
months,  with  the  not  unusual  result  that  the  end  of  the  root  or  process 
through  which  the  pus  has  discharged  has  become  roughened,  we 
should  not  expect  to  effect  a  cure  by  forcing  phenol  or  the  phenol 


Fig.  4. 


Fig. 


Fig.  4. — This  skiagraph,  taken  by  Lewis,  shows  an  abscess  with  extensive  resorption 
of  alveolar  process  between  the  central  and  lateral  roots,  both  of  which  had  been  previously 
filled  and  carried  jacket  crowns.  The  skiagraph  shows  the  later  root  perfectly  filled  and 
the  abscess  caused  by  the  imperfectly  filled  central.  These  cases  are  often  difficult  to 
diagnose. 

Fig.  5. — This  skiagraph,  taken  bv  Lewis,  shows  a  similar  case  to  that  illustrated  in 
Fig.  4.  It  was  difficult  to  determine  whether  the  abscess  came  from  the  central  or  lateral 
root.  The  skiagraph  shows  the  lateral  root  over-filled,  but  the  abscess  coming  from  the 
central. 


compound  through  the  sinus,  because  such  agents  as  these  have  no  ac- 
tion whatever  on  the  bony  structures.  The  author  desires  to  emphasize 
here  the  value  of  the  skiagraph  in  determining  the  extent  of  involve- 
ment and  the  nature  of  the  complication.  It  is  not  always  a  positive 
means  of  diagnosis,  but  it  is  a  material  aid  (see  Figs.  4  and  5). 

1.  Denuded  End  of  Root. — One  complication  we  may  expect  to 
find  in  abscesses  of  long  standing,  especially  in  the  variety  without  a 
sinus,  is  where  a  large  area  of  tissue  in  the  apical  space  has  been  ab- 
sorbed or  broken  down,  denuding  the  end  of  the  root  and  the  denuded 
portion  projecting  into  the  absorbed  area  (see  Fig.  6).  It  is  possible,  in 
these  cases,  to  make  pressure  over  the  end  of  the  root  and  mechanic- 


CHRONIC    ALVEOLAR    AHSCI  SS. 


315 


ally  evacuate  all  of  the  pus  above  the  apices;  but  we  cannot  expect  by 
this  means  to  evacuate  the  pus  below  and  surrounding  the  end  of  the 
root  projecting  into  the  space.  Jn  this  case  we  must  do  one  of  two 
things:  Force  some  stimulating  agent  through  the  end  of  the  root  into 
the  infected  area,  to  create  a  more  acute  condition;  or  surgically 
establish  a  sinus  through  the  overlying  process  and  soft  tissue,  and  treat 
as  an  ordinary  discharging  abscess.  While  the  author  does  not  hesi- 
tate to  adopt  the  latter  method  if  necessary  to  effect  a  cure,  it  will  be 
found  that  the  use  of  a  stimulating  agent  will  generally  suffice  in  these 
cases.  The  agents  recommended  are  a  50  per  cent,  solution  of 
phenolsulphonic  acid  or  a  15  per  cent,  solution  of  trichloracetic  acid. 
In  using  either  of  these  solutions,  the  pus  should  first  be  evacuated  as 


Fig.  6. — This  skiagraph,  taken   by  Ream,  shows  a  typical  abscess  without  a  sinus 
which  developed  from  an  imperfectly  filled  root  of  a  lateral  incisor. 


much  as  is  possible;  then  the  solution  selected  can  be  placed  in  the 
canal  and  gently  forced  through  the  apices  and  the  modified  formo- 
cresol  solution  sealed  in  the  canal.  One  or  two  treatments  will  usually 
be  sufficient  to  check  the  pus  formation,  when  the  case  can  be  treated 
in  the  ordinary  manner. 

2.  Resorbed  Root.  -Another  complication  of  both  varieties  of 
chronic  alveolar  abscess  is  where  the  pus  has  stood  in  contact  with  the 
end  of  the  root  sufficiently  long  to  cause  a  resorption,  leaving  a 
roughened  end  which  irritates  the  tissue  and  prevents  healing.  Some- 
times, also,  the  process  through  which  the  pus  has  burrowed  is  left 
with  sharp  edges.  In  all  such  complications  the  "acid  treatment" 
is  especially  indicated.  These  cases  generally  yield  nicely  to  the  treat- 
ment, if  phenolsulphonic  acid  is  used  as  the  agent  with  which  to  cau- 
terize the  sinus  and  stimulate  the  sluggish  cells. 


316  PRACTICAL    DENTAL    THERAPEUTICS. 

3.  Encystment  of  Root. — A  difficult  complication  to  treat  is 
where  an  abscess  occurs  on  a  root,  the  end  of  which  has  become  en- 
cysted from  deposits,  excementosis  or  other  causes.  In  order  to  effect 
a  cure  in  these  cases,  it  is  necessary  to  establish  a  sinus  and  remove 
the  deposits,  excise  the  root,  or  extract  the  tooth.  The  method  of 
excising  the  root  will  be  discussed  later. 

4.  Involving  Bone. — Every  acute  and  chronic  alveolar  abscess  in- 
vites bone  complication.  During  the  progress  of  the  abscess  the  bone- 
marrow  becomes  infected  by  the  pathogenic  bacteria  and  is  broken 
down  into  pus.  If  extraction  is  resorted  to  and  laceration  of  the  soft 
tissue  and  alveolar  margins  results,  a  mixed  infection  is  liable  to  follow, 
as  has  been  previously  explained  (p.  308,  Fig.  3).  The  germs  are 
highly  virulent,  and  among  which  are  frequently  found  the  diplococcus 
pneumoniae  and  the  tubercular  bacilli. 

In  these  cases  it  is  necessary  to  see  the  patient  frequently,  washing 
the  part  with  warm  antiseptic  solutions  and  covering  the  entire  exposed 
process  with  the  euroform  paste  or  other  stimulating  remedies.     The 


Fig.  7  shows  an  upper  second  bicuspid  exfoliated  by  Nature  with  the  entire  sur- 
rounding alveolar  process  attached.  This  result  followed  a  slight  traumatic  injury  to  the 
part,  shortly  after  the  pulp  had  been  removed  by  pressure  anesthesia.  The  first  bicuspid 
ultimately  became  so  loose  that  its  removal  was  necessary.  The  author  was  able  to  elicit 
a  previous  history  of  syphilis,  the  disease  having  been  cured  for  a  number  of  years. 

orthoform  will  control  the  pain  and  the  iodin  liberated  from  the  euro- 
phen  will  stimulate  and  disinfect  the  part.  If  gauze  is  used  in  applying 
the  paste,  it  should  be  changed  frequently;  for,  if  left  long,  it  invites 
further  infection,  even  when  saturated  at  first  with  the  oleaginous 
paste.  After  the  pain  subsides  bismuth  paste  may  be  freely  injected 
every  few  days. 

5.  Extensive  Necrosis. — Bone  infection  from  alveolar  abscesses 
often  results  in  either  caries  or  necrosis  of  bone.  Pus  is  formed  from 
the  breaking  down  of  the  tissues  and  fluids,  and,  in  case  of  caries,  es- 
capes through  several  sinuses.  The  porous  dead  bone  may  be  de- 
tected by  a  pointed  steel  probe.  In  necrosis  the  parts  involved  die 
en  masse,  and  the  sequestra  are  finally  loosened  and  gradually  work 


chronic:  ai.vi.oi.ar  absciss. 


3*7 


out  as  one  large  or  several  small  pieces.  In  cases  of  syphilitic  history, 
even  if  the  case  has  long  been  considered  cured,  there  is  a  great 
tendency  toward  necrosis  (see  Fig.  7).  The  treatment  here  is  largely 
surgical.  The  dead  hone  must  be  removed,  after  which  the  parts 
should  be  kept  clean  and  stimulation  used  until  healed.  It  is  gener- 
ally best  in  cases  of  necrosis  to  wait  for  Nature  to  separate  the  dead 
from  the  living  bone.  A  50  per  cent,  solution  of  phenolsulphonic  acid 
hastens  the  formation  of  the  sequestrum;  after  the  dead  bone  is  re- 
moved bismuth  paste  should  be  injected  until  the  part  heals. 


Fig.  8. 


Fig. 


Fig.  8. — This  skiagraph,  taken  by  Ream,  shows  a  large  abscess  cavity  under  the 
floor  of  the  nasal  and  antral  cavities,  the  result  of  the  death  and  decomposition  of  the 
pulp  in  the  lateral  incisor.  The  dark  spot  shows  the  outline  of  the  cavity  which  had  been 
injected  with  bismuth  paste  from  a  lingual  opening.  To  cure  the  case  it  was  necessary 
to  open  from  the  labial,  excise  the  lateral  root  and  thoroughly  curett  the  affected  bone. 
After  the  operation  the  case  was  first  packed  for  24  hours  with  euroform  gauze  to  control 
the  pain,  followed  with  the  injection  of  bismuth  paste  until  granulation  filled  the  cavity. 

Fig.  9. — This  skiagraph,  taken  by  Lewis,  shows  bismuth  paste  which  was  injected  into 
an  abscess  pocket.  Extensive  caries  of  bone  resulted  from  a  dead  pulp  in  the  cuspid  tooth. 
An  opening  was  made  both  labially  and  lingually,  the  part  curetted  and  packed  with 
euroform  gauze.  The  second  day  after  operation  the  bismuth  paste  was  injected,  when 
the  skiagraph  was  taken. 


6.  Involving  Vault. — Still  another  complication  often  difficult  to 
cure  is  where  the  pus  has  worked  its  way  through  the  lingual  plate  of 
bone  and  involves  the  vault  of  the  mouth  (see  Figs.  8  and  9).  The 
dense  fibrous  tissue  covering  the  vault  is  very  tough,  and  the  pus  often 
separates  the  periosteum  from  a  considerable  area  of  bone  before  ulti- 
mately discharging  into  the  mouth.  Generally  a  lancet  is  required 
to  evacuate  the  pus.  In  treating  these  conditions  it  is  essential  to  ex- 
plore the  affected  area,  using  a  sharp  steel  instrument  in  order  to  de- 
termine whether  there  is  caries  or  necrosis.  Unless  too  much  bone  is 
involved,  the  case  can  be  successfully  treated  by  first  making  a  liberal 
opening  with  a  sharp  bistoury  and,  if  necessary,  breaking  down  the 


318  PRACTICAL    DENTAL    THERAPEUTICS. 

sharp  edges  of  bone,  through  which  the  pus  has  burrowed,  with  a 
round  bur  having  a  long  shank,  after  which  the  sinus  should  be  estab- 
lished in  the  usual  manner,  using  a  considerable  quantity  of  the  bland 
solution.  Now  dry  the  canal  and  force  through  the  sinus  full  strength 
phenolsulphonic  acid.  Sometimes  it  is  advisable  to  place  a  piece  of 
blotting-paper  soaked  in  liquid  petroleum  over  the  lingual  opening 
when  forcing  the  acid  through.  This  causes  the  agent  to  spread 
and  come  in  contact  with  the  entire  area  involved.  Alcohol  and  the 
oils  will  neutralize  any  excess  of  the  phenolsulphonic  acid  that  may 
get  on  the  other  tissues  of  the  mouth.  This  treatment  should  be 
repeated  as  often  as  the  case  demands.  When  there  is  no  evidence  of 
pus  and  the  case  has  healed  sufficiently  so  that  there  is  only  a  watery 
discharge,  the  root  can  be  filled. 

7.  Secondary  Abscess  Pocket. — Occasionally  we  find  an  abscess 
of  the  discharging  variety  which  does  not  yield  to  our  general  treatment, 
yet  we  are  reasonably  certain  that  none  of  the  complications  so  far 
mentioned  are  present.  In  these  cases  we  can  suspect  a  secondary 
abscess  pocket.  This  is  especially  true  where  the  sinus  opened  into  the 
mouth  several  teeth  removed  from  the  affected  tooth.  This  pocket  can 
usually  be  discovered  by  the  aid  of  a  small  silver  probe.  The  treat- 
ment is  simple — all  that  is  necessary  is  to  open  the  pocket,  wash  it  out 
first  with  a  bland  solution,  then  inject  50  per  cent,  phenolsulphonic 
acid.  In  using  phenolsulphonic  acid  in  such  cases  it  cannot  be  in- 
jected through  the  tooth,  therefore  it  is  necessary  to  use  a  syringe — a 
glass  syringe  with  an  asbestos-packed  plunger  and  a  gold  or  a  platinum 
needle  should  be  used. 

8.  Involving  Antrum.— The  pus  in  making  its  exit  follows  the 
line  of  least  resistance,  and  sometimes  it  is  easier  to  work  its  way 
through  the  floor  of  the  antrum  than  through  the  labial  or  lingual  plate 
of  bone.  The  treatment  of  this  complication  is  of  sufficient  im- 
portance as  to  merit  discussion  by  itself,  which  will  be  considered 
later,  but  in  this  connection  it  is  well  to  remember  that  so  good  an 
authority  as  Kyle,  viewing  the  question  from  the  nasal  side,  finds  that 
fully  50  per  cent,  of  antral  diseases  are  of  dental  origin. 

Excision  of  Root. — In  all  complicated  abscesses  which  will  not 
yield  to  the  treatment  outlined  above,  we  can  often  save  the  root  by 
excising  its  end.  This  should  be  done  only  as  a  last  resort  and  then 
under  the  most  aseptic  conditions.  The  hands  of  the  operator,  as  well 
as  all  instruments  used,  should  be  thoroughly  sterilized.  Before 
operating,  the  root  should  be  filled  and  a  thorough  exploration  made 
that  the  amount  of  process  and  root  involved  may  be  noted.     A  local 


CHRONIC    AI  \  l.OI.AR     \HSCKSS. 


3*9 


anesthetic  injected  deeply  should  be  employed  and  a  circular  incision 
made.  The  opening  can  now  be  packed  with  gauz.e  dipped  in  a 
1:1,000  solution  of  adrenalin  chlorid  for  a  few  minutes.  In  all  large 
roots  the  author  prefers  following  the  method  of  Gilmer.     With  a 


Fig.  io. 


Fig.  ii. 


Fig.  io. — This  skiagraph,  taken  by  Ream,  shows  a  long  standing  abscess  on  an  upper 
left  lateral.     The  root  had  been  filled  with  lead. 

Fig.  ii  shows  the  same  case  the  day  after  the  root  end  was  excised.  The  pocket  is 
now  ready  to  be  filled  with  the  bismuth  paste. 

spear-shaped  drill  a  hole  can  be  made  through  the  center  of  the  root, 
after  which  the  root  is  easily  excised  with  a  fissure  bur,  placing  the  bur 
in  the  hole  and  drilling  mesially  and  distally.  It  is  often  difficult  to 
remove  the  end  after  the  excision  is  made.     This  can  be  done  with  a 


Fig.  12. — This  skiagraph,  taken  by  Lewis,  shows  an  abscess  which  developed  on  the 
distal  root  of  a  lower  molar,  after  the  mesial  root  had  been  previously  excised  and  a  bridge 
adjusted.  Thorough  curettraent  and  keeping  the  pocket  filled  with  bismuth  paste  cured 
the  condition. 

strong  hatchet  or  hoe  excavator,  an  elevator,  and  sometimes  with  small 
beaked  root-forceps.  After  removing  the  excised  end,  the  root  re- 
maining should  be  smoothed  with  a  round  bur  and  the  area  thoroughly 
curetted,  removing  any  necrosed  process  which  may  be  present      The 


320  PRACTICAL   DENTAL   THERAPEUTICS. 

wound  should  now  be  washed  with  an  antiseptic  solution  and  packed 
with  sterile  gauze  saturated  with  euroform  paste.  The  patient  should 
be  instructed  to  keep  the  mouth  as  clean  as  possible,  and  after  the  first 
packing  bismuth  paste  can  be  injected  into  the  wound  every  few  days 
until  granulation  fills  the  cavity.  Skiagraphs  showing  a  case  in  the 
author's  practice  is  illustrated  in  Figs.  10  and  n.  See  also  Fig.  12. 
Other  complications  are  illustrated  in  Figs.  13  and  14. 


Fig.  13.  Fig.  14. 

Fig.  13  shows  a  tumor  which  developed  in  the  apical  area  of  a  central  incisor,  which 
carried  a  Richmond  crown.     The  tooth  had  been  improperly  treated. 

Fig.  14  shows  a  central  incisor  carrying  a  Richmond  crown.  Pink  gutta-percha  can 
be  seen  in  the  apex  of  the  original  (^4),  showing  that  the  root  was  perfectly  filled  at  first; 
but  in  drilling  for  the  dowel  subsequently  the  dentist  punctured  the  root,  afterward  forcing 
gutta-percha  through  the  puncture  (B).  An  abscess  developed,  doubtless  from  lack  of 
asepsis. 

Whenever  the  operator  is  in  doubt  as  to  the  best  means  of  treating 
complicated  alveolar  abscesses,  he  should  never  hesitate  to  consult 
with  a  practitioner  who  has  had  more  experience  in  treating  these  cases. 
Such  a  course  cannot  be  construed  as  a  lack  of  knowledge,  but  is 
evidence  of  conservatism  and  progress. 

TREATMENT  OF  PUTRESCENT   PULPS  AND  ABSCESSES  IN 
DECIDUOUS  TEETH. 

In  treating  the  conditions  under  consideration  in  the  mouths 
of  children,  it  is  necessary  in  most  cases  to  modify  our  usual  method 
of  treatment.  Our  first  duty  here  is  to  gain  the  confidence  of  the  child. 
If  the  abscess  is  associated  with  a  deciduous  molar  which  we  would 
desire  to  save  for  at  least  a  year  or  two,  it  can  be  treated  nicely  in  the 
following  manner:  After  gaining  the  confidence  of  the  little  patient  the 
mouth  can  be  rinsed  with  an  antiseptic  solution — one  which  has  a 
pleasant  taste.  Then  open  into  the  pulp  chamber  and  place  a  pledget 
of  cotton  in  the  opening.  Now  mix  on  one  end  of  the  cement  slab  pre- 
cipitated calcium  phosphate  and  the  formocresol   remedy,   making  a 


CHRONIC   ALVEOLAR   ABSCESS.  32I 

stiff  paste.  On  the  other  end  of  the  slab  have  a  quick-setting  cement 
ready  to  mix.  Again  rinse  the  patient's  mouth  and,  keeping  the  cavity 
as  dry  as  possible,  gently  pack  the  paste  into  the  pulp  chamber  and  flow 
the  cement  over  it,  filling  the  cavity.  It  is  remarkable  how  rapidly 
these  abscesses  will  heal  and  remain  quiet  when  treated  in  this  manner, 
provided,  of  xourse,  there  be  no  caries  or  necrosis  of  bone.  If  it  is  de- 
sired to  keep  the  tooth  in  the  patient's  mouth  for  more  than  a  year,  it 
is  better  to  neutralize  the  putrescence  with  formocresol  as  usual, 
when  the  root-canals  can  be  flooded  with  eucapercha  compound  and 
the  entire  cavity  filled  with  gutta-percha. 


PERICEMENTAL  ABSCESS. 

GENERAL  CONSIDERATIONS. 

All  of  the  alveolar  abscesses  which  we  have  discussed  thus  far  have 
been  the  result  of  an  infection  in  the  apical  area,  the  infection  being  due 
to  pathogenic  bacteria,  poisonous  ptomains  and  irritating  gases,  which 
have  escaped  from  a  putrescent  root-canal.  There  is,  however,  an 
abscess  that  occurs  in  the  alveolar  region  about  the  roots  of  teeth,  not 
caused  from  the  source  mentioned.  This  particular  kind  of  abscess 
occurs  in  connection  with  live  teeth;  not  necessarily  so,  however. 
There  is  a  progressive  breaking  down  of  the  pericemental  membrane, 
and  in  dental  literature  it  is  called  a  pericemental  abscess.  The  cause  of 
this  particular  kind  of  abscess  is  rather  vague;  but  it  is  generally  sup- 
posed to  be  due  to  some  traumatic  injury.  It  frequently  occurs  on  the 
labial  surface  of  the  roots  of  the  anterior  teeth  involving  most  of  this 
surface.  They  have  also  been  known  to  occur  between  the  roots  of 
molar  teeth,  especially  the  upper  molars.  It  may  discharge  through  a 
sinus  near  the  apical  end  of  the  roots  or  at  the  gum  margin;  in  the 
latter  case  it  resembles  a  pyorrheal  pocket. 

THERAPEUTICS. 

For  convenience  in  outlining  our  treatment  for  a  pericemental 
abscess,  the  condition  may  be  classified  as  acute  and  chronic.  As 
a  rule,  there  is  very  little  pain  associated  with  either  variety  of 
pericemental  abscess.  In  the  acute  form,  which,  as  such,  is  ex- 
tremely difficult  to  diagnose,  the  patient  will  complain  of  "something 
being  wrong  with  a  particular  tooth."  About  all  that  can  be  done 
therapeutically  with  the  acute  form  is  to  pacify  the  patient  as  best  we 
can,  until  the  acute  abscess  develops  into  the  chronic  variety,  when  pus 
is  formed  and  discharges  and  a  sinus  is  established;  thus  the  diagnosis 
is  more  easily  made.  If  the  abscess  occurs  on  the  anterior  teeth  where 
the  area  involved  can  be  curetted  and  cauterized  it  will  generally  yield 
to  the  treatment;  but  the  treatment  of  a  chronic  pericemental  abscess 
on  molar  teeth  is  at  best  a  discouraging  procedure  and  practically  the 
only  permanent  cure  is  to  extract  the  affected  tooth.  In  those  cases 
where  the  area  can  be  reached,  an  opening,  if  necessary,  can  be  made 
through  the  gum,  the  root  thoroughly  scraped  and  polished;  then,  after 

322 


PERICEMENTAL  ABSCESS.  323 

washing  out  the  abscessed  area,  it  should  be  cauterized  with  some 
cauterizing  agent.  Nothing  gives  better  results  than  phenolsulphonic 
acid.  With  a  proper  glass  syringe  and  a  gold  or  platinum  needle, 
the  remedy  can  be  injected  into  the  abscess  pocket.  One  thorough 
treatment  should  effect  a  cure.  In  curetting  these  cases  it  is  far  better 
to  go  a  little  Beyond  the  affected  territory  rather  than  fail  to  remove  all 
of  the  affected  tissue  and  have  the  abscess  recur.  Where  the  abscess 
can  be  reached,  thorough  curettement  and  cauterization  will  effect  a  cure. 
That  portion  of  the  pericemental  membrane  which  has  been  detroyed 
will  perhaps  never  be  regenerated,  but  if  we  succeed  in  having  granu- 
lation fill  in  the  area  involved,  even  though  the  membrane  is  not  regen- 
erated over  that  particular  surface  of  the  root,  the  tooth  can  be  saved 
for  a  considerable  length  of  time. 


FILLING  ROOT-CANALS. 

GENERAL  CONSIDERATIONS. 

There  are  so  many  different  methods  of  filling  root-canals,  and 
there  seems  to  be  such  a  variance  of  opinion  as  to  the  best  method  of 
performing  this  operation,  that  it  is  with  a  degree  of  hesitancy  that 
the  author  attempts  to  discuss  this  subject.  This  operation  stands 
as  a  sort  of  dividing  line  between  the  subjects  of  therapeutics  and  oper- 
ative dentistry  proper.  In  discussing  this  subject,  the  author  will  pre- 
sent the  therapeutic  aspect,  and  describe  a  method  of  procedure  which 
has  proved  successful  in  his  practice. 

It  will  be  remembered  that  three  factors  were  emphasized  under 
the  Removal  of  Pulps  and  the  Subsequent  Treatment,  viz. : 

i.  Established  and  maintained  asepsis. 

2.  Preserve  the  color  of  the  tooth. 

3.  Thoroughly  fill  the  canal. 

The  author  suggests  filling  all  canals,  which  are  large  enough  for  a 
broach  to  enter,  with  gutta-percha  in  the  manner  which  will  be  sub- 
sequently described.  In  connection  with  the  preservation  of  the  color 
of  the  tooth,  it  should  be  mentioned  that  white  base  plate  gutta-percha 
should  be  used,  especially  for  the  purpose  of  dissolving  in  eucalyptol 
compound,  making  eucapercha  compound.  If  this  white  substance  is 
forced  into  the  tubuli  of  the  crown  of  the  tooth,  as  it  is  liable  to  be,  it 
will  not  change  the  color  of  the  tooth-structure  as  would  the  pink  gutta- 
percha. A  great  many  dentists  have  been  moistening  the  canal,  pre- 
vious to  filling  with  gutta-percha,  with  oil  of  eucalyptus;  and,  as  a 
result,  much  unnecessary  pericementitis  has  followed  this  operation. 
If  oil  of  eucalyptus  is  used  at  all,  the  refined  oil  only  should  be  selected; 
and  far  more  satisfactory  results  will  follow  the  use  of  eucalyptol,  the 
most  volatile  constituent  of  oil  of  eucalyptus.  While  eucalyptol  is 
irritating,  it  is  not  nearly  so  much  so  as  is  oil  of  eucalyptus.  The 
author  suggests  modifying  the  irritating  property  of  eucalyptol  and 
enhancing  its  antiseptic  power  by  combining  menthol  and  thymol,  as 
suggested  in  the  prescription  for  eucalyptol  compound  in  the  treat- 
ment of  nonseptic  pericementitis.      (Page  294.) 

In  this  proportion,  the  agents  added  do  not  interfere  with  the 

324 


FILLING    ROOT-CANALS.  325 

solvent  power  of  eucalyptol  for  gutta-percha;  but  If  the  amounts  are 
increased  to  any  appreciable  extent,  this  does  not  hold  true. 

In  filling  root-canals  it  is  always  the  safest  practice  to  adjust  the 
rubber  dam,  for  asepsis  must  be  established  and  maintained.  The 
same  agents  can  be  used  for  sterilizing  the  teeth  after  the  dam  is  ad- 
justed as  were  described  in  removing  pulps  by  the  anesthetization 
method.  The  canals  should  be  aseptic  before  the  operation  is  at- 
tempted. If  there  is  any  doubt  in  this  regard,  the  operation  should  be 
deferred  unti   the  canals  are  in  such  a  condition. 

Filling  Large  Canals. — In  filling  large  canals,  especially  those 
in  connection  with  which  abscesses  have  been  treated,  where  the  apex 
is  large  and  where  we  ought  not  to  expect  to  get  a  response  from  the 
patient  when  the  gutta-percha  cone  reaches  the  apex,  on  account  of 
the  resorption  in  the  apical  area,  it  is  best  to  measure  the  canal  and 
then  use  one  cone  which  approximately  fits  the  canal  rather  than  use 
two  or  three  smaller  cones  with  the  possibility  of  forcing  one  through 
the  apex  and  into  the  apical  area.  There  is  almost  as  much  danger 
of  forcing  the  root  filling  too  far  in  large  canals,  as  there  is  in  not  forcing 
it  far  enough  in  small  canals.  To  measure  the  canals,  cotton  can  be 
tightly  wrapped  around  a  smooth,  sterile  broach  and  inserted.  When 
by  repeated  trials  the  cotton  fits  the  canal,  a  cone  can  be  made  of  white 
base  plate  gutta-percha,  which  is  slightly  smaller  than  the  tightly 
wrapped  cotton.  The  canal  should  now  be  moistened  with  eucapercha 
compound,  working  the  latter  up  or  down  into  the  canals  with  a 
fine  smooth  broach,  exhausting  the  air.  If  cotton  is  wrapped  around 
the  broach  used  for  this  latter  purpose,  only  a  few  shreds  should  be 
used;  for  we  should  avoid  making  a  piston  out  of  the  broach  and  thus 
defeating  the  means  of  exhausting  the  air.  This  accomplished,  the 
cone  can  be  slowly  and  gently  pressed  to  place.  In  filling  large  canals 
from  which  live  pulps  have  recently  been  removed,  the  patient  will 
generally  flinch  before  the  cone  reaches  the  apex.  When  this  occurs, 
we  should  wait  a  few  moments,  when  the  cone  can  be  gently  pressed 
much  farther  without  causing  the  patient  to  flinch  a  second  time.  If 
these  precautions  are  observed,  they  will  be  the  means  of  preventing 
much  of  the  pericementitis  following  the  filling  of  root-canals. 

Filling  Small  Canals. — In  filling  all  canals  where  we  can  enter 
nicely  with  a  smooth  broach,  it  is  best  to  follow  the  technic  outlined 
above,  using  a  cone  which  will  enter  the  canal.  However  much  we 
may  regret  it,  there  are  canals,  especially  in  the  molar  teeth,  so  small 
and  tortuous  that  even  a  fine,  smooth  broach  will  not  enter,  at  least  to 
any  depth.     It  is  useless  to  try  to  fill  such  canals  with  a  gutta-percha 


326  PRACTICAL    DENTAL    THERAPEUTICS. 

cone.  The  methods  of  enlarging  the  canals  by  the  use  of  acids  and  caus- 
tics, as  referred  to  in  connection  with  the  destruction  of  pulp  tissue  in 
such  canals,  can  be  employed;  but  it  is  not  always  advisable  to  enlarge 
them  sufficiently  to  admit  a  small  cone.  After  the  larger  canal  or 
canals  in  a  multi-rooted  tooth  are  filled  in  the  ordinary  manner,  the 
smaller  ones  can  be  moistened  with  eucapercha  compound  and  this 
worked  up  or  down  into  the  canal.  This  process  should  be  kept  up 
for  some  time.  The  sides  of  the  pulp  chamber  can  now  be  moistened 
with  eucalyptol  compound  and  a  piece  of  base  plate  gutta-percha, 
selected  and  softened  in  the  flame,  can  be  packed  into  the  pulp 
chamber,  when  pressure  can  be  made  toward  the  small  canals  and 
the  plastic  gutta-percha  forced  into  them.  This  is  much  better  prac- 
tice than  simply  filling  the  mouth  of  the  canal  with  a  gutta-percha 
cone.  If  the  canal  is  so  small  and  tortuous  that  even  a  small 
broach  will  not  enter,  and  if  it  cannot  be  enlarged  by  the  use  of 
acids  or  caustics,  as  referred  to  previously,  it  is  good  practice  to 
make  a  paste  of  formocresol  and  thymolized  precipitated  calcium 
phosphate,  placing  the  paste  over  the  mouth  of  the  canal,  and,  after 
working  it  up  or  down  as  best  we  can,  covering  it  with  cement. 

As  previously  mentioned,  there  are  many  methods  of  filling  root 
canals  by  which  good  results  are  attained.  The  method  here  outlined 
has  served  the  author  well.  In  closing,  I  desire  to  say  that  no  reasonable 
amount  of  time  should  be  considered  lost  in  the  treatment  of  teeth 
preparatory  to  the  insertion  of  the  final  root-canal  filling. 


DISCOLORED  TEETH. 
GENERAL  CONSIDERATION. 

In  the  discussion  of  the  methods  of  removing  pulps  from  teeth 
and  the  subsequent  treatment,  the  treating  of  putrescent  pulps  and  the 
various  kinds  of  alveolar  abscesses,  the  author  endeavored  to  empha- 
size the  necessity  of  preserving  or  restoring  the  color  of  the  tooth.  There 
is,  perhaps,  nothing  more  annoying  to  a  conscientious  dentist  and  to 
an  appreciative  patient  than  a  discolored  tooth  in  the  patient's  mouth. 
If  the  precautions,  which  have  been  mentioned  throughout  this  work 
with  reference  to  this  factor,  are  observed  in  the  treatment  of  teeth,  the 
necessity  for  bleaching  may  often  be  avoided;  for  after  all  that  has  been 
written  on  this  subject  is  studied,  it  must  be  admitted  that  the  most 
successful  method  of  bleaching  teeth  is  to  so  treat  them  that  they  will 
not  need  to  be  bleached. 

Sources  of  Discoloration. — -There  are  three  principal  sources 
of  the  discoloration  of  tooth-structure,  viz., 

i.  Pulp  decomposition. 

2.  Remedial  agents. 

3.  Metallic  fillings. 

The  greatest  source  is  that  of  pulp  decomposition.  Many  teeth  con- 
taining putrescent  pulps  are  discolored  before  the  patient  presents 
for  treatment.  In  those  cases  where  the  color  is  not  lost  the  putrescent 
condition  can  be  corrected  and  the  color  preserved  by  the  method  of 
treatment  outlined  under  Putrescent  Pulps. 

Occasionally,  however,  teeth  have  been  observed  to  assume  a 
pinkish  hue  shortly  after  some  traumatic  injury,  rapid  regulation, 
or  after  some  irritating  drug  had  been  applied  to  a  small  exposure 
of  the  pulp,  as,  for  instance,  arsenic  trioxid.  Kirk  has  offered  a 
plausible  explanation  for  the  cause  of  this  immediate  discoloration. 
He  says:  "It  is  now  known  that  the  pink  staining  of  the  tooth  is 
brought  about  by  a  rupture  of  the  stroma  of  the  red  blood  disks 
liberating  their  contained  hemoglobin,  which  dissolves  in  the  plasma. 
forming  a  solution  of  hemoglobin  which  readily  penetrates  the  dentinal 
tubuli,  the  lumen  of  which  is  of  insufficient  diameter  to  admit  the 
unbroken  red  corpuscle.     This  pink  discoloration  resulting  from  the 

327 


328  PRACTICAL   DENTAL   THERAPEUTICS. 

infiltration  of  hemoglobin  solution  represents  the  first  stage  of  tooth 
discoloration.  The  pink  stain  readily  undergoes  alterations,  later  on 
assuming  a  brownish  tint,  due  to  the  breaking  down  of  the  highly 
complex  molecule  of  hemoglobin  into  a  reduced  product  known  as 
hematin." 

Manner  of  Discoloration. — There  are  two  ways  by  which  the 
discoloration  is  produced,  i.e.,  by  solutions  which  stain  the  cement- 
like substance  uniting  the  tubuli  and  by  the  ingress  into  the  tubuli 
of  insoluble  coloring  substances.  For  instance,  many  remedial 
agents  in  solution,  such  as  oil  of  cassia,  silver  nitrate,  etc.,  have  the 
property  of  staining  the  cementing  substance  and  producing  dis- 
colorations;  while  the  sulphids  formed  from  certain  metals,  as,  for 
example,  in  amalgam  fillings,  produce  discoloration  by  virtue  of 
being;  forced  into  the  tubular  structure  of  the  dentin.  If  more  care 
were  taken  in  selecting  remedial  agents,  used  in  the  treatment  of 
teeth,  which  would  not  stain  the  tooth-structure,  and  if  high-grade 
alloys  were  selected  in  making  amalgam  fillings,  the  cavity  properly 
prepared,  amalgam  inserted  and  polished  when  set,  there  would 
be  few  teeth  discolored  from  these  sources.  But,  as  has  been 
stated,  many  teeth  containing  putrescent  pulps  are  discolored  before 
the  patient  presents  for  treatment;  and,  inasmuch  as  this  is  by  far  the 
greatest  source,  it  is  well  to  try  to  ascertain  definitely  the  true  cause  of  the 
discolorations  from  this  source;  for  it  is  difficult  and  unsatisfactory 
to  try  to  bleach  a  tooth  when  we  have  no  knowledge  of  the  nature  of  the 
pigment  we  are  trying  to  bleach.1 

Principle  of  Bleaching. — The  principle  which  governs  the  suc- 
cessful bleaching  of  teeth  is  to  chemically  change  the  molecule  of  the 
pigment  in  such  a  manner  as  to  destroy  its  color,  or  chemically 
change  the  insoluble  coloring  substance  to  a  soluble  form,  when  it 
can  be  washed  out  of  the  tooth-structure. 

Important  Factors.— When  a  case  presents  for  bleaching  there 
are  three  important  factors  to  be  determined: 

1.  Ascertain,  if  possible,  the  "cause  of  the  discoloration. 

2.  Decide  whether  or  not  the  color  can  be  successfully  restored. 

3.  The  selection  of  the  proper  bleaching  agent  with  which  to 
restore  the  color. 

The  general  cause  of  the  discoloration  can  usually  be  ascertained 
from  the  history  of  the  case  as  related  by  the  patient.     Whether  or 

1  The  author  has  explained  the  chemistry  of  tooth-discoloration  from  pulp  decom- 
position in  Johnson's  "Text-book  of  Operative  Dentistry"  and  in  various  dental 
journals. 


DISC")L')RKI>    TEETH.  329 

not  the  tooth  can  h  -fully  bleached  depends  largely  upon  the 

cause  of  the  discoloration,  the  condition  of  the  tooth-structure,  and 
the  length  of  time  the  tooth  has  been  discolored.  Experience  will 
prove  that  the  teeth  which  will  permanently  retain  their  color,  after 
it  is  restored,  are  those  that  have  a  good  bulk  of  dentin  and  which 
dentin  can  be  protected  by  the  remaining  enamel  and  some  filling 
material,  preferably  porcelain  if  this  material  is  at  all  indicated.  I 
desire  to  emphasize  the  fact  that  it  is  folly  to  expect  a  tooth  to  retain 
color  any  length  of  time  after  once  being  bleached,  unless  the 
dentin  is  properly  protected. 

Having  ascertained  the  cause  of  the  discoloration  and  believing 
that  the  condition  of  the  tooth-structure  justifies  us  in  attempting  to 
bleach  the  tooth,  we  come  to  the  most  important  consideration,  viz., 
the  selection  of  the  bleaching  agent,  with  which  the  color  can  be  re- 
stored with  the  least  inconvenience  to  the  patient  and  operator. 

METHODS  OF  BLEACHING. 

All  of  the  methods  employed  in  bleaching  teeth  involve  more  or 
less  chemistry  and  from  a  chemic  viewpoint  there  are  two  general 
methods  of  bleaching  teeth — oxidation  and  reductio-n. 

I.  Oxidation. — This  general  method  is  of  two  kinds,  also,  direct 
and  indirect. 

1.  Direct. — By  direct  oxidation  is  meant  the  use  of  any  agent  or 
agents  from  which  oxygen  can  be  directly  obtained.  The  agents 
used  for  the  purpose  are: 

Sodium  dioxid.  Xa202. 

Twenty-five  per  cent,  ethereal  solution  of  hydrogen  dioxid,  H202. 
Alphozone,   ,COOH.CH2.CH2CO)202. 
Acetozone,  C  HCO.O.O.COCH3. 

Aluminum  chlorid,  A12C16,  and  a  three  percent,  aqueous  solution 
of  hydrogen  dioxid. 

alic   acid,   H2C204. 

2.  Indirect. — By  indirect  oxidation  is  meant  the  use  of  any  agent 
or  agents  by  which  oxygen  can  be  obtained  indirectly.  The  agents 
employed  are  such  as  will  liberate  nascent  chlorin,  CI,  a  chemically 
active  gas,  which,  in  the  presence  of  moisture,  seizes  upon  a  molecule 
of  water,  H20,  abstracts  the  atoms  of  hydrogen,  H,  forming  hydro- 
chloric acid,  HC1,  and  liberates  the  oxygen,  O,  in  the  nascent  state  as 
BaO+2d=2HCl+0    nascent. 


330  PRACTICAL   DENTAL    THERAPEUTICS. 

Some  of  the  agents  used  for  this  purpose  are: 

Aluminum  chlorid  and  a  freshly  prepared  Labarraque's  solution 
(Harlan). 

Chlorinated  lime  and  dilute  acetic  acid  (Truman). 
Powdered  alum,  A12K2(S04)4,  and  Labarraque's  solution. 
Solution  of  sodium  chlorid  electrically  decomposed. 

II.  Reduction. — By  reduction  is  meant  the  use  of  any  agent  or 
agents  which  will  abstract  oxygen  from  a  compound  containing  it. 
The  agents  which  have  been  recommended  are,  sodium  sulphite, 
Na2S03,  10  parts,  and  boric  acid,  H3B03,  7  parts.  These  are  mixed 
and  placed  within  the  tooth,  moistened  with  water  and  hermetically 
sealed  (Kirk).  A  reaction  occurs  between  the  two  substances,  with 
the  ultimate  formation  of  sulphurous  acid  which  has  a  great  affinity 
for  oxygen  and  is  therefore  a  good  reducing  agent.  In  some  cases 
where  the  tooth  has  been  discolored  by  remedial  agents,.and  where  it 
is  desired  to  break  up  the  color  molecule,  good  results  are  obtained  by 
this  method.  Whenever  the  method  is  used,  the  tooth  should  subse- 
quently be  thoroughly  washed  with  an  alkaline  solution,  such  as  a  10 
per  cent,  solution  of  sodium  bicarbonate  or  borax,  to  neutralize  the 
acid. 

In  most  cases  of  discoloration,  the  direct  oxidation  method  is  pref- 
erable; and,  in  view  of  the  fact  that  all  of  the  agents  used  in  the  indirect 
method  of  bleaching  depend  upon  the  generation  of  oxygen  for  their 
efficacy,  it  can  readily  be  understood  that  the  direct  method  is  far 
more  satisfactory.  The  fact,  also,  that  hydrochloric  acid  is  a  constant 
by-product  in  the  indirect  method,  thereby  creating  an  acid  medium, 
adds  to  the  objectionable  features  of  this  method;  for  manufacturers 
have  recognized  for  years  that  better  results  can  be  obtained  in  bleach- 
ing ivory,  wool,  hair,  feathers,  etc.,  when  the  bleaching  process  is 
carried  on  in  an  alkaline  medium.  This  is  likewise  true  in  bleaching 
teeth.  Believing,  then,  that  the  direct  oxidation  method  is  far  superior 
to  the  indirect,  I  shall  not  burden  my  readers  by  describing  the  latter 
method,  but  will  direct  attention  to  the  detailed  use  of  sodium  dioxid 
and  25  per  cent,  ethereal  solution  of  hydrogen  dioxid — both  direct 
oxidizing  agents,  and  which,  if  their  chemic  properties  are  known 
and  their  dental  application  understood,  the  author  believes  to  be  the 
best  agents  for  bleaching  teeth  thus  far  suggested  to  the  profession. 

Using  Sodium  Dioxid. — Sodium  dioxid  occurs  in  commerce  as  a 
yellow  powder  and  is  readily  decomposed  by  water  into  caustic  soda  and 
oxygen.     Because  of  this  latter  fact,  much  of  the  product  obtained  from 


nismi  <>ki  I)    ll  1  I'll.  331 

wholesale  druggists  labeled"  sodium  dioxid,"  is  nothing  but  caustic  soda. 
This  accounts  for  the  fact  that  many  dentists  have  tried  this  method 
o!"  bleaching  and  failed  to  get  results.  The  fault  is  not  with  the  method, 
but  with  the  powder  used.  In  order  that  we  might  be  able  to  ascertain 
the  efficacy  of  the  chemical,  some  years  ago  I  devised  a  simple  chemic 
test  for  this  purpose.  In  a  clean,  dry  test-tube  place  about  15  gr. 
(1.0  gm.)  of  the  powder  and  to  it  add  30  min.  (2.0  c.c.)  of  water.  If  the 
specimen  is  good  sodium  dioxid,  enough  oxygen  should  be  generated 
to  kindle  a  glowing  splinter  held  at  the  mouth  of  the  tube.  Having 
tested  the  chemical  and  proved  it  to  be  sodium  dioxid,  and  not  caustic 
soda,  the  next  thing  is  to  properly  prepare  the  tooth,  which,  of  course, 
should  have  been  previously  treated  and  the  root  filled  with  white 
gutta-percha. 

Preparation  of  the  Tooth. — The  rubber  dam  should  be  adjusted, 
if  possible,  without  the  use  of  the  steel  clamp.  The  ligature  should  be 
wrapped  twice  around  each  tooth  included  in  the  dam,  which  should  be 
at  least  two  teeth  on  either  side  of  the  one  to  be  bleached.  This  will  pre- 
vent the  by-product,  caustic  soda,  from  getting  on  the  soft  tissue  and 
destroying  it.  The  lower  third  of  the  root  filling  should  now  be 
removed  with  a  good-sized  round  bur — it  being  necessary,  for  perma- 
nent results,  to  bleach  the  tooth  rootwise  as  far  as  possible.  We  are 
now  ready  to  apply  our  bleaching  agent. 

Making  the  Application. — -Both  the  dry  sodium  dioxid  and  a 
solution  made  by  carefully  dusting  the  powder  into  ice-water  is  recom- 
mended to  be  used.  The  best  results  are  obtained  by  using  the  dry 
powder,  placing  it  into  the  cavity  and  with  a  platinum  broach  or 
pointed  glass  instrument,  work  the  powder  well  up  into  the  canal  from 
which  the  root  filling  has  been  removed.  Care  should  be  taken  not  to 
use  steel  instruments,  as  oxygen  will  attack  the  steel,  forming  ferric 
oxid,  and  therefore  we  may  get  into  the  tooth  the  pigment  we  are  try- 
ing to  remove.  In  some  cases  it  is  rather  difficult  to  place  the  powder 
in  the  cavity  without  getting  it  on  the  patient's  face  or  clothing.  To 
overcome  this  a  strip  of  unannealed  1:1,000  platinum  foil  can  be 
placed  between  the  discolored  and  adjacent  tooth,  letting  it  extend 
above  or  below  the  cutting-edge,  as  the  case  may  be,  when  white  base 
plate  gutta-percha  can  be  warmed  and  pressed  against  the  lingual  sur- 
faces of  the  teeth  included  in  the  dam.  This  forms  a  pocket  on  the 
labial  side  into  which  the  powder  can  be  easily  placed,  using  a  little 
gold  or  platinum  spoon  or  spatula.  In  more  difficult  cases  a  paste 
can  be  made  of  the  powder  and  chloroform,  in  which  it  is  insoluble, 
quickly  packing  the  paste  into  the  cavity,  evaporating  the  chloroform, 


332  PRACTICAL    DENTAL    THERAPEUTICS. 

leaving  the  dry  powder  where  it  is  desired.  Distilled  water  is  now 
dropped  upon  the  powder,  causing  a  lively  effervescence,  and  the  fol- 
lowing reaction  takes  place: 

Na202+H20=2NaOH  +  0  (nascent). 

This  nascent  oxygen  is  a  powerful  oxidizing  agent.  It  attacks  and 
rapidly  destroys  any  organic  matter  which  may  be  present  in  the 
tubular  structure  of  the  dentin.  It  also  thoroughly  bleaches  vegetable 
colors  and  acts  upon  any  iron  compounds  which  may  have  produced 
the  discoloration.  It  converts  ferric  hydroxid,  if  present,  into  ferric 
oxid — still  an  insoluble  compound.  If  ferrous  sulphid  is  present  in 
the  moist  state,  it  may  be  converted  into  ferrous  sulphate,  a  soluble 
salt;  but  in  the  presence  of  caustic  soda  it  would  be  reprecipitated  as 
ferrous  hydroxid,  which,  in  turn,  in  the  presence  of  oxygen,  is  at  once 
reconverted  into  ferric  oxid.  Therefore,  the  pigment  to  be  removed, 
if  our  chemic  reasoning  is  correct  as  to  the  cause  of  the  discoloration 
from  pulp  decomposition,  is  ferric  oxid,  an  insoluble  compound,  and 
must  be  removed  mechanically  by  washing  the  tooth.  Its  removal  is 
facilitated  by  the  by-product,  caustic  soda,  acting  upon  any  fatty 
substances — fat  being  an  end-product  of  the  putrefaction  of  the  proteid 
material — which  may  be  present  in  the  tubuli.  The  result  of  this 
action  being  a  soluble  soap,  the  removal  of  which  by  washing,  aids, 
as  stated,  the  mechanical  removal  of  the  insoluble  pigment. 

It  is  the  opinion  of  the  author  that  the  ultimate  success  depends 
quite  as  much  upon  the  mechanical  removal  of  the  coloring  matter  as 
upon  the  chemic  destruction  of  it;  therefore,  the  necessity  for  thor- 
oughly, washing  the  tooth  after  each  application  of  the  bleaching  agent. 
Warm  distilled  water  should  be  used  in  a  strong  syringe,  letting  a 
moist  sponge  absorb  the  water.  The  cavity  is  now  dried,  the  color 
of  the  tooth  observed  and  the  process  repeated,  if  necessary.  Usually 
two  or  three  applications  are  sufficient.  If  the  color  is  not  readily 
restored,  the  dentin  can  be  saturated  with  a  2  per  cent,  solution 
of  sulphuric  acid  which  can  now  enter  the  tubuli  and  chemically 
convert  the  oxids,  that  may  not  have  been  mechanically  or  other- 
wise removed  by  the  saponifying  and  washing  process,  into  sulphates. 
The  salts  produced  are  freely  soluble,  and  can  readily  be  washed  out 
by  again  using  the  warm  water. 

Final  Treatment. — When  the  tooth  is  satisfactorily  bleached,  a 
paste  of  precipitated  calcium  phosphate  and  distilled  water  can  be 
placed  in  the  cavity,  packed  into  the  lower  third  of  the  root  and 
burnished,  with  a  warm  burnisher,  against  all  exposed  dentin.     This 


DISC KIM     II   II  II.  33$ 

is  thoroughly  dried  by  burnishing,  the  excess  removed,  and  a  light- 
colored,  quick-setting  cement  used  to  form  a  base  for  the  final  filling. 

Using  25  per  cent.  Ethereal  Solution  of  Hydrogen  Dioxid. — 
A  25  per  cent,  ethereal  solution  of  hydrogen  dioxid,  called  also  caustic 
pyrozone,  occurs  in  specially  prepared  and  hermetically  sealed  glass 
tubes.  The  "date  of  its  preparation  is  stamped  upon  the  tube  to 
guarantee  its  activity,  for  its  value  as  a  bleaching  agent  depends  upon 
the  volume  of  nascent  oxygen  which  is  liberated.  It  is  therefore  impor- 
tant that  a  good  specimen  of  the  agent  be  obtained.  Care  must 
be  exercised  in  opening  the  tube,  which  should  be  wrapped  in  a  cold, 
wet  towel  and  held  firmly  in  the  left  hand.  With  a  sharp  file  make 
a  groove  around  the  pointed  end  of  the  tube,  after  which  this  end  may 
be  easily  broken  with  a  pair  of  pliers,  pointing  the  tube  away  from  the 
face.  A  sharp  file  should  be  used  as  a  dull  one  might  produce  a  spark 
and  cause  an  explosion. 

Preparation  of  the  Tooth. — The  tooth  should  be  prepared 
exactly  as  in  using  sodium  dioxid,  except  the  cavity  of  the  tooth  should 
be  moistened  with  an  alkaline  solution  (10  per  cent,  solution  of  borax 
or  sodium  bicarbonate)  before  making  the  application.  This  is  done 
in  recognition  of  the  fact  that  the  bleaching  process  is  more  successful 
if  carried  on  in  an  alkaline  medium. 

Making  the  Application. — There  are  some  cavities  into  which  it 
is  difficult  to  place  sodium  dioxid,  even  if  a  paste  has  been  made  with 
chloroform  on  account  of  the  rapid  evaporation  of  the  latter.  This  is 
especially  true  where  the  cavity  is  small  and  in  the  lingual  surface  of 
one  of  the  six  upper  anterior  teeth.  Teeth  containing  such  cavities 
can  usually  be  bleached  more  conveniently  by  using  caustic  pyrozone. 
The  remedy  can  be  applied  in  the  canal  loosely  on  cotton.  To  hasten 
the  liberation  of  oxygen,  a  heated  platinum  wire  can  be  gently  placed  on 
the  cotton.  The  wire  should  not  be  too  hot,  as  the  heat  may  cause  a 
flame  from  the  ether  in  the  solution.  Heated  dry  air  may  also  be  used 
for  the  same  purpose.  After  each  application  the  tooth  structure 
should  be  thoroughly  washed  with  a  warm  alkaline  solution,  and 
the  process  repeated  until  the  color  is  satisfactorily  restored. 

If  after  repeating  the  application  two  or  three  times,  the 
tooth  is  not  satisfactorily  bleached,  the  solution  may  be  hermetically 
sealed  in  the  cavity.  If  the  cavity  is  small  and  on  the  lingual  surface, 
the  sealing  can  best  be  done  by  the  use  of  gutta-percha  (not  temporary 
stopping).  The  excess  of  solution  can  be  dried  from  the  cavity  and  the 
hot  gutta-percha  applied,  the  heat  of  which  hastens  the  liberation  of 
oxygen  which,  together  with  the  expansion  of  the  confined  ether,  is 


334  PRACTICAL    DENTAL    THERAPEUTICS. 

carried  into  the  entire  tubular  structure  of  the  dentin.  The  final 
treatment  is  exactly  the  same  as  in  using  sodium  dioxid. 

The  other  direct  oxidizing  agents  are  used  in  practically  the  same 
way.  The  alphozone  and  acetozone  powder  can  be  placed  in  the 
cavity  moistened  with  an  alkaline  solution  and  hermetically  sealed. 
The  volume  of  oxygen  liberated  from  these  agents  is  not  great,  and  the 
process  of  bleaching,  therefore,  is  much  slower  than  when  sodium 
dioxid  or  caustic  pyrozone  is  used. 

In  conclusion,  I  desire  to  say  that  in  the  bleaching  of  teeth  we  find 
a  practical  application  of  the  science  of  chemistry  to  the  practice  of 
dentistry,  and  that  in  the  discoloration  of  tooth-structure  from  the 
various  sources  can  be  found  a  fruitful  field  for  further  investigation. 


ANTRUM  OF  HIGHMORE. 

GENERAL  CONSIDERATIONS. 

The  antrum  of  Highmore,  or  maxillary  antrum,  is  a  chamber  or 
cavity  in  the  body  of  the  superior  maxillary  bone  on  either  side  of  the 
jaw.  It  should  be  remembered  in  connection  with  the  therapeutics 
of  the  diseases  of  the  antrum  that  the  cavity  is  normally  lined  with 
mucous  membrane,  which  is  continuous  from  the  nasal  cavity  through 
a  small  opening,  called  the  ostium  maxillare;  and  that  the  cavity  varies 
in  location  and  size,  capable  of  containing  from  two  drams  (8.0  c.c.)  to 
sometimes  one  ounce  (30.0  c.c.)  of  fluid.  Fortunately,  the  dentist,  in 
general  practice,  is  not  often  called  upon  to  treat  diseases  of  the  maxil- 
lary antrum,  but  when  a  case  presents  of  purely  dental  origin,  he 
should  be  prepared  to  make  a  correct  diagnosis  and  to  properly  treat 
the  case. 

Causes  of  Diseases  of  the  Antrum. — There  are  many  contribut- 
ing causes  of  diseases  of  the  maxillary  antrum,  among  the  more  im- 
portant of  which  are: 

1.  Dental  Conditions. — It  is  quite  generally  conceded  by  both 
rhinologists  and  dentists  that  the  teeth,  or  conditions  associated  with 
the  teeth,  are  the  greatest  source  by  which  the  membrane  lining  the 
chamber  may  become  irritated  to  the  extent  of  bringing  about  a  de- 
generation of  the  cells,  when  infection  is  liable  to  occur  and  pus  result. 
It  has  been  previously  mentioned  that  one  of  the  serious  complications 
of  alveolar  abscesses  was  where  the  pus  became  evacuated  into  the 
antral  cavity,  rather  than  working  its  way  through  the  labial  or  buccal, 
and  sometimes  through  the  lingual  plate  of  bone  emptying  into  the 
mouth,  as  is  the  case  usually.  The  author  reports  here  two  cases  in  the 
college  infirmary  where  the  student  had  removed  a  vital  pulp  and 
entered  the  antrum  through  the  canal,  showing  that  all  that  separated 
the  end  of  the  root  from  the  floor  of  the  antrum  was  the  mucoperios- 
teum,  which  the  student  penetrated.  One  case  was  the  lingual  canal 
of  a  first  molar,  and  the  other  the  canal  of  a  second  bicuspid.  If  ab- 
scesses occur  in  connection  with  teeth  thus  situated  in  the  jaw,  the  an- 
trum would  at  once  become  involved. 

2.  Catarrhal  Inflammation. — Since  the  Schneiderian  membrane 
which  lines  the  nasal  cavity  passes  through  the  ostium  maxillare  and  the 

-t  -.  - 


336  PRACTICAL   DENTAL    THERAPEUTICS. 

continuation  of  it  lines  the  antral  cavity,  any  inflammation  of  the  nasal 
mucous  membrane,  if  continuous  and  progressive,  may  involve  the 
antrum.  Especially  is  this  true  with  patients  having  catarrh,  influenza, 
or  grip.     Even  an  acute  coryza  may  seriously  involve  the  antrum. 

3.  Foreign  Material. — Foreign  material  constitutes  another  pro- 
lific source  of  disease  of  the  antrum.  Teeth,  especially  third  molars, 
have  been  known  to  erupt  into  the  antrum;  dentigerous  cysts  and 
polypi  are  frequently  found;  and,  occasionally,  in  the  careless  extraction 
of  a  pointed  root,  and  even  at  times  when  due  care  and  judgment  is 
exercised,  if  the  root  is  badly  decayed,  it  may  be  forced  by  the  forceps 
into  the  antral  cavity. 

4.  Traumatism. — The  antrum  frequently  becomes  involved  as  a 
result  of  some  traumatic  injury,  such  as  a  blow,  etc. 

It  is  frequently  difficult  to  make  a  correct  and  positive  diagnosis 
of  antral  disease.  The  symptoms  generally  are  of  the  subjective 
variety,  unless  the  cause  is  some  traumatic  injury,  in  which  case  the 
diagnosis  is  readily  made.  The  symptoms  which  aid  in  arriving  at  a 
diagnosis  are:  A  sense  of  fullness  on  the  affected  side,  at  times  the 
pressure  may  be  so  great  as  to  cause  the  eye  to  distend  from  its  orbit; 
frequently  an  odor  and  discharge  of  bloody  pus  or  mucus  through  the 
nose,  especially  when  the  patient  coughs  or  sneezes,  or  when  he  lies 
in  a  certain  position.  The  use  of  the  X-ray  and  the  little  electric 
mouth-lamp,  while  by  no  means  positive,  are  invaluable  aids  in  mak- 
ing the  diagnosis.  By  pulling  down  the  shades  and  making  the  room 
as  dark  as  possible,  and  placing  the  electric  mouth-lamp  on  the  lingual 
side  of  the  teeth  a  dead  pulp  may  be  detected  which  is  causing  the 
trouble.  Placing  the  lamp  higher  in  the  vault,  the  antrum,  if  diseased, 
will  generally  present  a  more  cloudy  or  foggy  appearance  than  will 
the  healthy  antrum.  After  making  the  diagnosis,'  the  next  important 
step  is  to  decide  on  the  method  of  treatment.  If  no  dental  condition 
seems  to  be  causing  the  disease,  the  patient  should  be  referred  to  a 
rhinologist  for  further  examination;  but  if  the  diseased  condition  of 
the  antrum  is  of  dental  origin,  it  is  the  prerogative  of  the  dentist  to 
treat  the  case,  if  he  so  desires. 

THERAPEUTICS. 

The  treatment  is  of  two  kinds — surgical  and  medicinal. 

1.  Surgical  Treatment. — The  surgical  treatment  of  diseases 
of  the  antrum  will  be  discussed  here  but  briefly.  To  intelligently 
treat  the  condition  it  is,  of  course,  essential  to  find  the  cause  and  re- 
move it.     Let  it  be  understood  that  this  does  not  necessarily  mean 


A\  I  Ki  M    ni     EIOHMOR]  .  337 

that  if  the  cause  of  the  antral  trouble  is  an  abscessed  tooth,  it  is  acces- 
sary to  extract  the  tooth.  Frequently,  by  treating  the  affected  tooth 
and  opening  into  the  antrum  and  washing  out  the  cavity,  the  case  will 
yield  nicely.  Whether  it  is  necessary  to  extract  the  offending  tooth 
is  often  a  difficult  problem  to  solve.  Many  teeth  have  been  need- 
lessly sacrificed  in  the  surgical  treatment  of  diseases  of  the  maxillary 
antrum,  especially  by  the  general  surgeon;  while,  on  the  other  hand, 
many  antrums  have  become  chronically  diseased,  which  condition 
might  have  been  avoided  and  the  case  cured  during  its  incipiency, 
had  it  not  been  for  the  presumed  conservativeness  of  dentists  especi- 
ally, in  their  efforts  to  cure  the  antral  disease  and  at  the  same  time 
save  the  tooth.  It  should  be  remembered  that  important  as  every 
tooth  is — a  healthy  antrum  is  of  greater  importance.  In  making 
this  statement  the  author  does  not  mean  to  encourage  the  needless 
extraction  of  teeth  in  connection  with  the  surgical  treatment. 

The  site  of  making  the  opening  depends  upon  the  conditions  as 
found.  Probably  no  two  cases  will  need  exactly  the  same  kind  of 
opening.  It  may  be  made  through  a  tooth-socket,  just  posterior  to 
the  canine  fossa,  between  the  roots  of  teeth,  or  through  the  nose.  The 
latter  opening  should  be  made  by  a  rhinologist,  if  necessary.  The 
tendency  at  first  is  to  make  the  opening  too  small  rather  than  large 
enough.  In  many  cases  it  is  necessary  to  have  the  opening  sufficiently 
large  to  make  an  ocular  or  digital  examination.  A  thorough  examina- 
tion at  this  stage  of  the  operation  will  determine  whether  the  cavity 
needs  curettment  or  simply  the  establishment  of  drainage  and  evacu- 
ation of  the  pus  or  mucoserous  fluid. 

It  is  seldom  necessary  to  administer  a  general  anesthetic  other 
than  nitrous  oxid  and  oxygen  for  the  purpose  of  opening  into  the  antrum 
painlessly.  It  may  be  accomplished  in  most  cases  practically  without 
pain  by  the  use  of  local  anesthetics.  With  the  soft  tissues  anesthetized 
there  is  little  pain  produced  in  drilling  through  the  bone.  Where 
curettment  is  indicated,  a  general  anesthetic  had  better  be  given. 
Nitrous  oxid  and  oxygen  serves  the  purpose  admirably.  We  now 
come  to  the  phase  of  the  subject  of  most  interest  from  our  point  of 
view — the  therapeutics.  Before  discussing  the  drugs  used  in  treating 
diseases  of  the  antrum  of  Highmore,  I  desire  to  emphasize  the  fact 
that  it  matters  little  what  drugs  are  used  as  long  as  they  are  practically 
nonirritating  and  antiseptic,  if  the  surgical  treatment  has  been  all 
that  is  required.  If  the  cause  has  not  been  surgically  removed  or 
corrected,  drugs  will  be  of  little  avail;  for  this  reason  the  surgical 
treatment  has  been  discussed  here  briefly. 


338  PRACTICAL   DENTAL    THERAPEUTICS. 

2.  Medicinal  Treatment. — The  therapeutics  of  the  condition 
under  consideration  consists  in  washing  the  antral  cavity  with  bland 
remedies  for  the  purpose  of  disposing  of  the  pus  and  mucoserous 
fluid;  this  to  be  followed  by  antiseptic  and  stimulating  remedies. 
Any  bland  solution  may  be  used  which  is  nonirritating  and  antiseptic, 
providing  the  odor  and  taste  of  the  agent  employed  is  not  objectionable. 
A  warm  saturated  solution  of  boric  acid  serves  the  purpose  admirably. 
The  author,  however,  prefers  using  a  warm  sterile  normal  salt  solution. 
This  may  be  used  in  a  fountain  syringe,  having  the  latter  placed  on  the 
wall  as  high  as  convenient  so  that  considerable  force  may  be  exerted  in 
the  washing  process.  A  glass  or  hard  rubber  point  should  be  attached 
to  the  rubber  tubing,  and  should  be  of  such  shape  and  size  as  to  pass 
easily  into  the  opening.  The  escape  of  fluid  from  the  syringe  should 
be  controlled  by  a  stop-cock.  By  this  means  the  cavity  can  be  well 
flushed  out,  using  a  considerable  quantity  of  the  liquid.  In  the  absence 
of  a  fountain  syringe,  a  strong  water  syringe  may  be  used.  The  normal 
saline  solution  also  acts  as  a  stimulant  to  the  mucous  membrane. 
After  thoroughly  washing  the  cavity,  most  of  the  solution  which  natur- 
ally remains  can  be  absorbed  with  cotton  and  the  cavity  injected  full  of 
some  antiseptic  and  stimulating  remedy.  Brophy  recommends  argyrol, 
using  all  the  way  from  a  10  to  a  50  per  cent,  solution. 

Beck  suggests  using  bismuth  paste.  This  has  the  distinct  ad- 
vantage of  completely  filling  the  space  with  a  semi-solid,  oleaginous 
paste,  which  guards  against  septic  invasion  from  the  mouth,  and  at  the 
same  time  holds  the  stimulating  drug  in  contact  with  the  entire  mem- 
brane of  the  cavity.  Some  care  must  be  exercised  in  making  the  injec- 
tion so  as  not  to  force  the  paste  into  communicating  sinuses.  The 
injection  may  be  repeated  as  often  as  the  necessity  of  the  case  demands. 
If  there  be  no  complication,  two  or  three  injections,  at  intervals  of  two 
or  three  days,  will  generally  suffice. 

There  is  little  necessity  for  using  strong  disinfectant  or  cauterizing 
agents  in  the  medicinal  treatment  of  diseases  of  the  maxillary  antrum. 
If  the  case  does  not  yield  to  the  treatment  here  given,  some  complication 
may  be  expected,  for  which  see  works  on  Oral  Surgery. 


PYORRHEA   ALVEOLARIS. 
GENERAL  CONSIDERATIONS. 

Because  of  the  customary  use  of  the  term,  and  for  want  of  a  better 
one,  this  much-named  disease  has  been  called,  throughout  this  work, 
pyorrhea  alveolar  is.  The  true  pathology  and  etiology  of  this  disease  is 
yet  an  unsolved  problem,  notwithstanding  the  fact  that  its  solution 
has  been  attempted  by  the  most  scientific  men  of  the  profession. 
Whether  the  disease  is  of  purely  local  origin  or  is  a  local  manifestation 
of  some  constitutional  disorder  will  not  be  discussed  here.  The 
author  is  of  the  opinion  that  a  mistake  has  been  made  by  the  profession 
generally  in  grouping  all  of  the  disorders  commonly  called  pyorrhea 
alveolaris  under  one  heading  and  endeavoring  to  effect  a  cure  of  the 
entire  group  by  a  common  treatment.  It  is  true  that  the  treatment  of 
the  various  diseases  affecting  the  gum,  pericemental,  and  alveolar 
tissues  have  many  things  in  common,  yet  the  correct  treatment  must 
necessarily  involve  special  measures  to  meet  the  demands  of  a  given 
case.  Therefore,  for  convenience  in  outlining  our  treatment  the  various 
disorders  so  commonly  grouped  under  the  heading  of  pyorrhea  al- 
veolaris will  be  arbitrarily  divided  into  three  classes.  It  must  be 
understood,  however,  that  in  reality  no  distinct  line  of  demarcation 
can  be  drawn.  The  division  is  made  purely  for  convenience  in  study- 
ing the  disease  from  the  therapeutic  point  of  view. 

DESCRIPTION  OF  CLASSES. 

Class  I. — -This  class  includes  such  cases  as  often  present  where 
upon  examination  it  will  be  noticed  that  around  several  teeth  in  the 
mouth,  just  under  the  free  margin  of  the  gum,  there  is  a  hard,  dark, 
flint-like,  annular  deposit,  which  in  some  instances  nearly  and  often- 
times completely  encircles  the  tooth.  This  deposit  comes  from  the 
blood,  and  is  known  as  scrumal  calculus.  It  is  caused  by  some  local 
irritant  at  the  gum  margin,  generally  oral  filth  and  bacteria,  which 
results  in  gingivitis — always  a  characteristic  symptom  of  this  class. 
There  may  or  may  not  be  pus,  generally  there  is  not;  the  pockets,  if  any, 
are  shallow.  It  will  usually  be  noticed  that  there  is  more  or  less 
salivary  deposits  also  on  the  lingual  surfaces  of  the  lower  anterior  teeth 

339 


340  PRACTICAL   DENTAL   THERAPEUTICS. 

and  on  the  buccal  surfaces  of  the  upper  first  and  second  molars 
The  general  condition  of  the  mouth  shows  every  evidence  of  neglect, 
which  may  be  considered  the  cause  of  this  class  of  pyorrhea  alveolaris. 
Fig.  15  shows  the  extent  to  which  salivary  deposits  may  accumulate 
in  a  neglected  mouth. 

Class  II. — This  class  is  what  might  properly  be  called  true 
pyorrhea  alveolaris.  In  it  will  be  considered  those  aggravated  cases 
wherein  there  is  no  evidence  of  gingivitis;  the  gum,  in  fact,  is  anemic 
rather  than  hyperemic,  and  is  gradually  receding  from  the  neck  of  the 
tooth.  The  pericemental  membrane  is  being  rapidly  destroyed;  the 
alveolar  process  is  resorbed — virtually  melting  away;  the  pockets  are 


Fig.  15. — This  shows  the  extent  to  which  salivary  calculus  will  form  on  the  roots  of 
the  lower  anterior  teeth  in  some  mouths,  if  neglected.  The  crown  is  nearly  covered  as  is 
also  most  of  the  root — only  a  small  portion  near  the  apex  being  free  from  deposit. 

deep  and  variously  located  around  the  single  root  of  a  tooth,  and  often- 
times between  the  roots  of  multi-rooted  teeth.  Pus  is  generally  present, 
and  there  may  or  may  not  be  hard  deposits.  Unless  the  disease  is 
checked,  there  is  a  progressive  loosening  of  the  teeth,  to  the  extent  that 
they  ultimately  drop  out.  The  cause  of  this  class  is  unknown.  It  may 
be  a  bacterium,  but  as  yet  no  specific  germ  has  been  satisfactorily 
demonstrated  to  be  the  exciting  agent,  though  the  presence  of  various 
pathogenic  germs  have  been  scientifically  proven,  as  is  evidenced 
also  clinically  by  the  pus  formation.  Surely  the  cause  cannot  be 
neglect  on  the  part  of  the  patient,  for  the  disease  occurs  and  often  per- 
sists in  the  mouths  of  patients  who  are  scrupulously  clean  so  far  as  the 
toilet  of  the  mouth  is  concerned.  The  cause  in  far  too  many  instances 
can  rather  be  tracted  to  neglect  on  the  part  of  the  family  dentist,  who 
either  failed  to  recognize  and  correct  the  disease  in  its  incipiency,  or, 
recognizing  it,  informed  the  patient  that  nothing  could  be  done  and 
advised  letting  it  go,  and  ultimately  extracting  the  teeth.  It  is  sadly 
to  be  regretted  that  so  many  teeth  have  been  needlessly  lost  in  the  past 


PYORRHEA  ALVEOLARIS.  341 

because  of  the  seeming  indifference  of  dentists;  but  the  wave  of  pro- 
phylaxis that  is  floating  over  the  profession  to-day,  due  to  the  efforts  of 
D.  D.  Smith  and  others,  is  an  encouraging  sign  that  individual  dentists 
are  either  equipping  themselves  to  combat  the  disease] or  are  referring 
the  patients  thus  afflicted  to  dentists  who  are  so  equipped.  Fig.  16 
illustrates  a  typical  case  of  this  class. 

Class  III.— In  this  class  will  be  considered  those  cases  in  which 
we  are  reasonably  certain  that  the  local  condition  in  the  mouth  is  at 
least  aggravated  if  not  entirely  due  to  some  systemic  derangement.  1 1  nas 
been  quite  clearly  demonstrated  by  Pierce,  Rhein,  Talbot,  Kirk,  Fletcher, 
Endleman,  and  others  that  at  least  certain  kinds  of  pyorrhea  alveo- 
laris  is  closely  associated  with,  if  not  caused  by,  such  general  diseases 


Fig.  16  shows  recession  of  gum  tissue  due  to  the  resorption  of  the  alveolar  process 
between  the  central  incisors — the  result  of  pyorrhea  alveolaris. 

and  conditions  as  syphilis,  tuberculosis,  actinomycosis,  diabetes,  gout, 
rheumatism,  osteomyelitis,  salivation,  phosphor  poisoning,  and  faulty 
metabolism  in  general.  The  symptoms  here  are  variable,  and  depend 
largely  upon  the  general  complication.  In  such  diseases  as  syphilis, 
tuberculosis,  actinomycosis,  and  osteomyelitis,  the  alveolar  process  is 
extensively  involved  and  usually  rapidly  resorbed,  the  teeth  are  loosened, 
there  is  generally  an  absence  of  hard  deposits,  the  pus  is  persistent, 
and  recovery  is  much  slower  than  usual.  In  diabetes  the  gums  are 
often  turgid  and  raw,  the  pericemental  membrane  is  inflamed  and 
highly  sensitive,  there  is  a  tendency  toward  the  formation  of  serumal 
deposits,  and  pus  may  or  may  not  be  present.  In  gout  or  rheumatism 
there  is  more  or  less  neuralgia,  serumal  deposits  are  generally  present 
and  attached  to  the  tooth  nearer  the  apex  of  the  root  than  is  the  case 
ordinarily.  The  mouth  symptoms  of  salivation  or  mercurial  stom- 
atitis and  phosphor  poisoning  have  been  elsewhere  described.  In 
faulty  metabolism  the  symptoms  are  variable,  none  of  which  have 
been  demonstrated  to  be  truly  characteristic  of  the  general  condition. 
With  this  understanding  of  the  conditions  which  present  in  the  various 
classes  of  the  disease  under  consideration,  we  will  now  discuss  the 
treatment. 


342 


PRACTICAL    DENTAL    THERAPEUTICS. 


THERAPEUTICS. 


When  cases  of  pyorrhea  alveolaris  present  for  treatment,  the  first 
important  consideration  is  to  impress  upon  the  mind  of  the  patients 
the  fact  that  you  must  have  their  hearty  cooperation,  and  that  in 
order  to  obtain  permanent  results  it  will  be  necessary  for  them  to 
follow  your  instructions  closely.  There  is  perhaps  no  condition  which 
dentists  are  called  upon  to  treat  wherin  the  confidence,  and  espe- 
cially the  cooperation  of  the  patient  is  of  such  vital  importance,  so  far 
as  permanent  results  are  concerned,  as  in  the  treatment  of  true  pyor- 
rhea alveolaris;  and  it  is  truly  surprising  what  good  results  can  be 
accomplished  by  the  conscientious  and  persistent  efforts  of  both  dentist 
and  patient. 

Before  undertaking  the  treatment  of  a  case,  then,  there  should 
be  a  distinct  understanding  as  to  what  may  reasonably  be  expected. 
The  discerning  patients  naturally  will  want  to  know  at  the  outset  if  their 
cases  can  be  cured.  The  word  "cure"  here  is  but  a  relative  term,  and 
an  explanation  should  be  made  in  regard  to  what  a  so-called  cure 
includes.  It  does  not  mean  that  the  lost  tissues — gum,  pericemental, 
and  alveolar — can  be  restored.  It  should  mean,  however,  that  the 
teeth  treated  can  ultimately  be  made  healthy,  comfortable,  and  useful, 
so  far  as  mastication  is  concerned.  Any  tooth  which  cannot  be  reason- 
ably expected  to  be  restored  to  this  condition  had  better  be  considered 
a  hopeless  tooth  and  extracted  at  once,  and  there  are  many  such  in 
the  mouths  of  pyorrheal  patients. 

While  the  presence  of  pus,  which  is  constantly  being  mixed  and 
swallowed  with  the  saliva  and  food,  is  of  greater  importance,  so  far 
as  health  is  concerned,  than  is  the  looseness  of  the  teeth  in  the  jaw, 
patients,  as  a  rule,  are  more  interested  in  the  latter  phase  of  the  question 
and  are  always  anxious  to  know  whether  the  now  loosened  teeth  will  be- 
come firmly  fixed  in  the  jaw  after  the  treatment.  This  all  depends 
upon  the  case  at  hand  and  the  mechanical  treatment  involved.  In  the 
past  too  much  dependence  has  been  placed  in  drugs,  and  too  much  also 
has  been  left  to  Nature  to  tighten  the  teeth,  when  such  should  not  be  ex- 
pected on  account  of  the  extensive  loss  of  tissues;  and  the  conscientious 
dentist  who  makes  extravagant  statements  in  this  respect  will  cause 
much  disappointment  to  both  himself  and  to  the  patient.  It  is  surpris- 
ing, at  times,  how  loosened  pyorrheal  teeth  will  tighten  in  the  jaw  under 
proper  treatment  without  mechanical  assistance,  but  too- much  should 
not  be  promised  in  this  respect.  The  author  desires  to  speak  plainly 
on  this  point,  for  herein  often  lies  the  greatest  source  of  disappointment. 


PYOKR1II  A    ALVEOLARIS.  343 

Unless  the  end  of  the  root  is  resorbed,  leaving  it  roughened,  the  pus 
formation  can  be  checked,  the  gum  can  be  made  to  resume  a  healthy 
appearance,  but  many  times  the  teeth,  without  mechanical  aid,  will 
QOl  materially  tighten,  though  otherwise  they  are  perfectly  healthy 
and  comfortable.  Their  usefulness,  of  course,  is  impaired  on  account 
of  their  being  loose. 

A  thorough  understanding  at  the  beginning  of  the  treatment,  then, 
serves  as  a  means  of  stimulating  confidence  on  the  part  of  the  patient  in 
the  operator's  ability  to  meet  the  conditions  as  found  and  the  con- 
scientiousness with  which  he  works.  No  dentist  should  undertake 
the  treatment  of  a  case  of  true  pyorrhea  alveolaris  unless  he  is  equipped 
to  render  the  best  possible  service,  considering  always  the  personal 
equation,  and  then  only  with  the  understanding  that  both  he  and  the 
patient  are  to  work  in  harmony — each  exerting  their  best  efforts  to 
eradicate  the  disease.  It  is  far  better  not  to  undertake  the  treatment 
of  a  case  than  to  have  it  end  in  disappointment. 

The  detailed  treatment  of  the  three  classes  into  which  the  disorders 
commonly  called  pyorrhea  alveolaris  have  been  divided  will  be  consid- 
ered separately,  for  herein  lies  the  value  of  making  the  subdivisions. 
The  treatment  is  of  three  kinds — surgical,  medicinal,  and  mechanical. 

CLASS  I. 

i.  Surgical  Treatment. — In  this  class,  it  will  be  remembered, 
deposits  are  always  in  evidence.  The  first  step  in  the  treatment  is  to 
remove  the  deposits.  This  is  accomplished  by  instrumentation,  care 
being  taken  to  remove  the  irritant  material  without  undue  injury  to 
gum,  pericemental,  and  tooth-structures.  The  instruments  which  the 
author  uses  for  this  purpose  are  the  Logan-Buckley  set,  illustrations 
and  brief  descriptions  of  which  are  found  in  Fig.  17.  Another 
very  excellent  set  of  instruments  is  known  as  the  Carr  set.  By  the  use 
of  either  of  these  sets  of  instruments  the  deposits  can  be  removed  with 
a  minimum  amount  of  injury  to  the  structures  involved.  Mawhinney 
has  especially  emphasized  the  injury  done  to  the  so-called  dental 
ligament  and  the  other  soft  tissues  by  careless  instrumentation,  and 
Patterson,  James,  Hartzell,  and  others  have  demonstrated  the  fact 
that  better  results  are  obtained  when  the  deposits  are  removed  in  such  a 
manner  as  to  leave  the  tooth-surface  smooth  and  easily  polished. 

Before  beginning  the  scaling  process  the  mouth  should  be  thor- 
oughly sprayed  or  rinsed  with  an  antiseptic  solution.  For  this  purpose 
the  author  uses  cinnamon  water  to  which  about  2  per  cent,  of  alcohol 


;44 


PRACTICAL    DENTAL    THERAPEUTICS. 


■=5. 


=£ 


FlG.  17. — Logan-Buckley  Set  of  Pyorrhea  and  Prophylactic  Instruments.     For  descrip- 
tion of  their  uses,  see  next  page. 


PYORR1II .  \    AIAKOI.ARIS.  345 

is  added.  The  cinnamon  water  is  an  agreeable  solution,  and  the 
alcohol  aids  in  removing  the  mucoid  material  with  which  the  teeth  in 
this  class  of  cases  are  generally  coated.  A  glassful  of  the  cinnamon 
water  should  also  be  in  a  convenient  place.  This  solution  can  be 
colored  pink  or  a  reddish  tinge  by  adding  a  small  amount  of  tincture 
of  cudbear.  -The  object  in  having  the  solution  colored  is  to  prevent 
the  patient  from  seeing  the  blood  which  is  always  more  or  less  in 
evidence  in  scaling  these  teeth  on  occount  of  the  gingivitis — a  char- 
acteristic symptom  of  this  class.  The  solution  is  used  with  a  strong 
water  syringe  as  often  as  is  necessary  to  clear  the  field  of  operation. 
The  scaling  should  be  begun  on  some  certain  tooth  in  the  mouth  and 
this  should  not  be  left  until  it  is  thoroughly  scaled.  This  can  only  be 
done  with  any  degree  of  certainly  by  following  some  definite  system. 
By  using  either  of  the  sets  of  instruments  mentioned,  the  scaling  can  be 
done  systematically.  With  the  L.-B.  set,  the  author  begins  on  the 
mesiobuccal  surface  of  the  upper  third  molar,  and  with  the  six  in- 
struments designed  for  the  purpose  one  can  work  completely  around 
the  tooth  in  an  intelligent  manner.  From  here  we  can  proceed  from 
one  tooth  to  another  around  the  arch,  using  the  instruments  designed 
for  the  various  surfaces.  If  there  be  a  bulky  deposit,  such  for  in- 
stance as  salivary  deposits,  this  should  be  removed  first  with  the  hook 
instrument  designed  especially  for  this  purpose. 

After  an  instrument  has  been  used  the  point  at  least  should  be 
kept  immersed  in  an  antiseptic  solution  during  the  entire  time  the  scal- 


BRIEF  DESCRIPTION  OF  THEIR  USES. 

These  instruments  are  so  designed  that  the  teeth  may  be  scaled  systematically. 
Beginning  on  the  mesiobuccal  surface  of  an  upper  molar  or  bicuspid  tooth,  the  in- 
struments are  used  as  follows:  No.  i  for  the  mesiobuccal,  No.  2  for  the  buccal,  No.  3 
for  the  distobuccal,  No.  4  for  the  distolingual,  No.  5  for  the  lingual,  and  No.  6  for  the 
mesiolingual  surfaces.  These  six  instruments,  therefore,  scale  systematically  around 
the  tooth.  If  at  any  point  a  pocket  is  found  too  deep  to  be  reached  with  these  instruments, 
their  counterparts,  except  with  a  narrower  point  and  exaggerated  in  form,  are  found  in 
Nos.  16  to  21  inclusive.  For  example,  No.  16  is  the  exaggerated  form  of  No.  1,  and  so  on 
with  the  entire  six  instruments.  For  the  lower  teeth  the  positions  of  the  instruments  are 
exactly  reversed,  i.  e.,  Nos.  1  and  16  are  here  used  on  the  mesiolingual  surface,  etc.  With 
one  or  the  other  of  these  groups  of  six  instruments  the  molar  and  bicuspid  teeth  can  be 
scaled,  except  occasionally  where  deep  pockets  are  found  between  the  roots  of  molar  teeth 
and  on  the  lingual  surface  of  the  divergent  lingual  root  of  upper  molars.  For  these  ex- 
ceptional cases,  Nos.  9  and  10  are  right  and  left  and  are  employed  for  scaling  between  the 
roots  of  molars,  and  Nos.  24  and  25  are  right  and  left  for  the  lingual  surface  of  a  divergent 
lingual  root  of  upper  molars.  No.  23  is  for  the  distal  surfaces  of  posterior  teeth  (third 
molars). 

For  the  anterior  teeth,  upper  and  lower,  No.  7  is  designed  for  the  lingual  surfaces, 
and  No.  8  for  the  labial.  In  cases  where  there  is  a  deep  lingual  pocket  which  cannot  be 
reached  with  No.  7,  No.  22,  the  exaggerated  form,  can  be  used.  No.  11  is  a  push  instru- 
ment used  in  removing  deposit  from  between  crowded  and  irregular  teeth.  No.  15  is  a 
general  hook  for  removing  the  bulky  deposit  before  the  more  delicate  instruments  are  used. 
Nos.  12,  13,  and  14  are  prophylactic  instruments  which  can  be  used  with  either  a  push 
or  pull  movement  and  will  be  found  useful  in  removing  superficial  decay  and  in  smoothing 
and  polishing  rough  surfaces. 


546 


PRACTICAL    DENTAL    THERAPEUTICS. 


ing  is  being  done.  This  can  best  be  done  by  having  a  tray  which  is 
designed  to  hold  the  instruments  in  their  proper  place.  Such  a  tray 
with  the  entire  L.-B.  set  of  instruments  in  their  proper  places  is  illus- 
trated in  Figs.  18  and  10. 


Fig.  iS  shows  the  instruments  in  their  proper  places  in  the  tray  ready  for  use. 

The  instruments  are  presumed  to  be  sterile  before  they  are  used, 
it  is  therefore  unnecessary  to  have  a  strong  disinfecting  solution  in  the 
tray.     Such  a  solution  would  either  act  upon  the  instruments  or  taste 


Fig.  19  shows  how  the  inner  rack  can  be  removed  for  the  purpose  of  sterilization. 

badly  when  the  instrument  is  placed  in  the  patient's  mouth,  for  the 
necessary  instrument  should  be  taken  directly  from  the  rack  of  the  tray 
and  used  in  the  mouth.     A  pleasant  antiseptic  solution,  therefore, 


PYORRHEA   Al A  1 10]  AKIS.  347 

should  be  in  the  tray.  Jt  isa  principle  in  surgery  to  avoid  the  presence 
of  germs  by  having  the  instruments  sterile  before  using  rather  than  to 
endeavor  to  kill  the  germ  by  the  use  of  strong  disfectants  during  the 
operation.  The  author  uses  a  20  per  cent,  solution  of  phenol  com- 
pound in  glycerin,  and  of  this  about  10  min.  (0.6  c.c.)  is  added  to 
about  1/2  pirrt  (240.0  c.c.)  of  sterile  water,  which  is  in  the  tray.  This 
solution  can  also  be  colored  with  tincture  of  cubbear  to  conceal  the 
blood. 

The  pockets  here,  if  any,  are  not  deep;  the  deposits  are  readily 
removed,  and  a  number  of  teeth  may  be  scaled  at  once  sitting.  Unless 
there  be  some  good  reason  for  extending  the  length  of  time  of  the 
operation,  it  should  be  limited  to  one  hour,  and  the  scaling  process 
should  be  stopped  in  sufficient  time  to  permit  a  thorough  prophylactic 
treatment  with  orange  wood,  pumice,  and  tape, according  to  the  method 
of  D.  D.  Smith,  before  applying  the  medicinal  treatment.  The  teeth 
here  are  not  loose  and,  therefore,  they  need  no  mechanical  support. 
A  record  should  be  kept  of  the  teeth  treated  at  each  sitting,  so  that  we 
may  know  exactly  where  to  begin  when  the  patient  returns. 

2.  Medicinal  Treatment. — After  the  teeth  have  been  thoroughly 
scaled  and  polished,  the  mouth  should  again  be  thoroughly  sprayed 
with  the  antiseptic  solution,  forcing  it  well  between  the  teeth  and 
around  the  gum  margins  to  mechanically  remove  any  loose  deposit, 
and  pumice  which  may  be  left  from  the  polishing.  By  the  use  of 
cottonoid  rolls  the  parts  treated  can  be  kept  dry  and  an  application 
made  of  some  astringent  remedy.  This  can  be  worked  with  a  glass 
instrument  under  the  free  margin  of  the  gum  and  over  the  gum  septum, 
keeping  the  parts  dry  for  a  few  moments,  when  the  mouth  can  again 
be  thoroughly  sprayed  and  rinsed  with  the  antiseptic  solution.  If 
the  teeth  are  at  all  responsive  to  heat  and  cold,  the  solutions  used 
should  always  be  warmed  to  the  temperature  of  the  body.  As  a  local 
astringent  in  these  cases,  the  author  suggests  the  following: 

1$ — Potassii  iodidi,  o  i j  (8.0  gm.) 

Iodi  (crys.),  oijss  (10.0  gm.) 

Zinci  phenolsulphonatis,  0  i j  (8.0  gm.) 

Aquae,  fSvj  (24.0  gm.) 

Glycerini,  foiijss  (14.0  gm.). — M. 
Sig. — Use  as  directed  above. 

The  patients  should  now  be  instructed  how  to  properly  brush,  mas- 
sage, and  care  for  their  teeth  generally,  prescriptions  should  be  written 
for  a  tooth-powder  or  paste  and  an  antiseptic  mouth-wash,  and  the 
patient  dismissed  until  a  second   sitting.     In  giving  the  instruction 


348  PRACTICAL   DENTAL   THERAPEUTICS. 

relative  to  brushing  the  teeth  and  massaging  the  gums,  it  should  be 
emphasized  that  the  gums  should  be  vigorously  brushed  as  well  as 
the  teeth — thus  we  get  the  benefit  of  massage.  Many  hand  and 
electrical  appliances  are  also  on  the  market  for  massaging  the  gums. 

The  above  treatment,  in  practically  every  detail,  should  be  re- 
peated at  each  sitting  until  the  mouth  is  in  good  condition,  after 
which  there  will  probably  be  little  need  for  further  medication.  The 
patient  should  be  requested  to  return  at  frequent  intervals  that  the  case 
may  be  watched,  and  each  time  the  patient  returns  an  examination 
should  be  made  with  respect  to  the  care  given  the  teeth.  If  all  is 
well,  the  patients  should  be  complimented,  if  not,  they  should  be 
cautioned  accordingly. 

The  general  prescribing  of  mouth-washes  containing  highly 
astringent  drugs,  as  the  zinc  salts,  in  the  treatment  of  pyorrhea  areo- 
laris, in  the  opinion  of  the  author,  is  wrong.  It  is  true  that  certain 
tissues  of  the  mouth  needs  be  constringed  and  stimulated  to  healthy 
activity,  but  surely  the  entire  mucous  membrane  of  the  mouth  does 
not  need  to  be  so  treated.  Cook  has  shown  that  the  continuous  use 
of  astringent  mouth-washes  interferes  for  hours  with  the  action  of 
the  ptyalin  upon  starchy  foods.  The  astringent  remedy  should  be 
applied  by  the  dentist  to  the  parts  only  in  need  of  such  treatment,  and 
an  antiseptic  mouth-wash,  together  with  the  proper  brush,  tooth-powder 
or  paste,  and  other  utensils  for  mouth  toilet  is  all  the  patient  should 
use.  If  the  patient  is  to  use  an  astringent  remedy  at  all,  the  constring- 
ing  agents  should  rather  be  a  constituent  of  a  tooth-paste  than  of  a 
mouth- wash.     A  prescription  for  a  tooth-paste  follows: 

1$ — Calcii  carbonatis  ppt.,  §iijss  (112.0  gm.) 

Saponis,  oss  (16.0  gm.) 

Sodii  benzoatis,  3j  (4.0  gm.) 
Eucalyptolis, 

Olei  menthae  piperitae,  aa     m.  x  (0.6  c.c.) 

Thymolis,  gr.  iv  (0.25  gm.) 

Saccharini,  gr.  iij  (0.2  gm.) 
Glycerini,                        q.  s.  ad.     pasta. — M. 
Sig. — Use  as  a  tooth-paste. 

As  a  mouth-wash  any  known  antiseptic  solution  can  be  prescribed. 
It  is  as  unnecessary  as  it  is  unwise  for  the  dentist  to  prescribe  the 
"cure-all"  mouth-washes  or  those  the  constituents  of  which  are 
to  him  unknown.  The  official  mouth-wash  (Liquor  Antisepticus, 
U.  S.  P.)  or  Dobell's  solution  may  be  prescribed  and  diluted  to  suit 
the  case.     The  formula  for  the  official  solution  follows: 


I'MiRKIll    \    .\  I A  I  "I   \KIS. 

Boric  Acid,  5  dr-  (2°-°  gm) 

Benzoic  Add,  15  gr.  (i  .o  gm.) 

Thymol,  15  gr-  (i-o  gm.) 

Eucalyptol,  4  min.  (0.25  c.c.) 

Oil  of  Gaultheria,  4  niin.  (0.25  c.c.) 

Oil  of  Peppermint,  8  min.  (0.5  c.c.) 
Oil  of  Thyme,  2  min.  (0.1  c.c.) 

Alcohol,  8  M.  oz.  (240.0  c.c.) 
Water,  to  make  1  qt.  (1,000.0  c.c.) 

In  prescribing  this  solution  it  is  never  necessary  to  remember  all 
of  the  various  drugs  and  their  quantities.  We  can  take  advantage 
of  the  fact  that  the  solution  is  recognized  by  the  United  States  Phar- 
macopeia and  write  its  official  title,  as: 

R — Liquoris  antiseptici,  f  3  viij  (240.  o  c.c.) 

Sig. — Dilute  with  one-half  of  warm  water  and  use  as  an  antiseptic 
mouth-wash. 

It  is  well  to  remember,  however,  that  the  solution  contains  about 
2  per  cent,  of  boric  acid,  0.1  per  cent,  of  benzoic  acid  and  thymol, 
25  per  cent,  of  alcohol,  and  other  aromatics  and  antiseptics  added  to 
water  as  the  vehicle.  Herein  is  illustrated  a  practical  application  of 
a  knowledge  of  the  Pharmacopeia. 

In  those  cases  complicated  by  indigestion  and  where  the  patient 
complains  of  a  sour  taste  in  the  mouth,  especially  on  rising  in  the 
morning,  due  either  to  local  fermentation  or  to  the  regurgitation  of 
acid  from  the  stomach,  the  condition  may  be  corrected  by  the  following 
prescription: 

R,— Sodii  bicarbonatis,  oj  (4-0  gm.) 

Infusi  gentianae  comp.,  foiij  (90.0  c.c.) — M. 

Sig. — Take  a  tablespoonful  before  meals  and  on  retiring. 

Where  the  sour  taste  comes  purely  from  fermentation  in  the 
mouth,  all  that  is  necessary  is  to  have  the  patients  use  frequently  a 
warm  solution  of  sodium  bicarbonate,  or  the  following  alkaline  and 
antiseptic  mouth-wash  may  be  prescribed. 

IJ — Sodii  bicarbonatis, 

Sodii  boratis,  aa     5ss(2.ogm.) 
Thymolis, 

Mentholis,  aa     gr.  ss  (0.03  gm.) 

Alcoholis,  foijss  (10.0  c.c.) 

Glycerini,  f  oij  (8.0  c.c.) 

Aquae  cinnamomi,  q.  s.  ad.     f 5 viij  (240.0  c.c.) — M. 
Sig. — Use  wherever  an  alkaline  and  antiseptic  mouth-wash    is 
indicated. 


350  PRACTICAL    DENTAL    THERAPEUTICS. 

CLASS  II. 

i.  Surgical  Treatment. — In  this  class  of  cases  we  are  dealing 
with  what  may  very  properly  be  called  true  pyorrhea  alveolaris,  and 
in  the  surgical  treatment  it  is  especially  necessary  to  use  such  instru- 
ments as  will  accomplish  our  end  in  a  definite  and  certain  manner. 
Here  the  exaggerated  forms  of  the  L.-B.  set  and  those  designed  for 
scaling  between  the  roots  of  molar  teeth  will  be  found  extremely  useful. 
If  deposits  are  present,  they  must  be  removed,  observing  the  same 
precautions  as  have  been  elsewhere  mentioned.  In  the  absence  of 
deposits,  the  pockets,  including  both  the  affected  tooth-surface  and 
alveolar  process,  must  be  thoroughly  curetted.  We  have  here  a  more 
aggravated  condition  with  which  to  deal,  and  from  one  to  four  teeth  will 
doubtless  be  all  that  should  be  treated  at  one  time,  for  the  teeth  thus 
operated  upon  are  usually  sore  and  more  or  less  sensitive  to  thermal 
changes;  therefore,  the  lesser  number  of  teeth  treated,  the  greater  will 
be  the  comfort  of  the  patient.  The  pockets  are  generally  deep  in  this 
class  of  cases,  and  compressed  air  is  an  excellent  agent  to  use  for 
clearing  the  field  and  locating  pockets. 

Indications  for  the  Removal  of  Pulps. — The  question  of  re- 
moving the  pulps  from  the  affected  teeth  in  this  class  of  cases  is  an 
important  one.  It  may  be  safely  stated  that  there  are  at  least  two  in- 
dications for  pulp  removal,  viz. :  (i)  where  the  pockets  are  deep  and 
the  infection  in  the  apical  area  has  left  the  pulp,  if  still  alive,  in  a  low 
state  of  vitality,  and  (2)  where  the  tooth  is  so  acutely  sensitive  as  to 
be  of  constant  annoyance  to  the  patient.  The  latter  condition  may 
often  be  overcome,  if  a  posterior  tooth,  by  cauterizing  the  exposed 
cementum  with  silver  nitrate  (see  p.  81),  and  the  transitory  sensitive- 
ness following  the  scaling  and  polishing  of  the  teeth  may  generally  be 
reduced  by  polishing  the  surfaces  with  moist  sodium  bicarbonate,  and 
having  the  patient  rinse  the  mouth,  especially  before  retiring,  with  a 
warm  sodium  bicarbonate  solution. 

It  has  been  clinically  observed  by  White,  of  Nashville,  and  others 
that  the  removal  of  the  pulp  of  a  badly  affected  pyorrheal  tooth  is 
followed  by  a  more  rapid  response  to  the  local  treatment  of  the  disease. 
The  theory  has  been  advanced  that  in  the  removal  of  the  pulp  the  entire 
circulation  of  the  tooth  is  thrown  to  the  sluggish  pericemental  mem- 
brane and  thus  stimulation  is  brought  about.  This  is  an  erroneous 
idea,  for  Noyes  and  Broomell  have  clearly  demonstrated  histologically 
that  the  pericemental  membrane  normally  is  well  supplied  with 
blood-vessels,  and  that  to  extirpate  the  pulp  would  not  materially  affect 


PYORRHEA    VLVEOLARIS. 


351 


the  circulation  to  this  membrane.  However,  there  are  many  cases 
wherein  the  removal  of  the  pulp  is  clearly  indicated  oot,  however, 
because  of  the  supposed  stimulation  which  results,  but  because  of 
its  low  state  of  vitality  and  ultimate-  death,  in  which  case  the-  pyor- 
rhea] condition  is  liable  to  be  complicated  by  the  presence  of  an 
alveolar  absoess.  Fig.  20  illustrates  the  result  of  a  mistaken  diag- 
nosis, where  a  pyorrhea!  condition  was  treated  as  an  abscess. 


Fig.  20. — This  skiagraph,  taken  by  Lewis,  shows  the  result  of  an  incorrect  diagnosis. 
Pus  was  flowing  from  between  the  two  central  incisors  and  from  between  the  left  central 
and  lateral  incisors.  The  condition  was  mistaken  by  the  dentist  for  an  alveolar  abscess, 
who  drilled  into  the  left  central  only  to  find  a  live  pulp,  which  was  removed  and  root  filled. 
In  the  operation  the  perfect  natural  crown  was  so  mutilated  that  a  Logan  crown  was 
subsequently  adjusted.  The  pus  still  continuing  to  flow,  an  attempt  was  made  to  open 
into  the  lateral,  as  the  skiagraph  shows.  On  finding  another  live  pulp,  the  dentist  became 
discouraged,  to  say  nothing  about  the  patient,  and  referred  the  case.  The  curettment 
of  two  rather  stubborn  pyorrheal  pockets  effected  a  cure. 


Denuded  Teeth. — Whenever  a  single  root  of  a  multi-rooted  tooth  is 
practically  denuded  of  its  pericemental  attachment,  with  the  remaining 
roots  in  fairly  good  condition,  the  badly  affected  root  should  be  com- 
pletely excised.  Such  a  condition  is  illustrated  in  Figs.  21  and  22. 
This  necessitates  of  course  the  removal  of  the  pulp  and  the  filling  of  the 
root.    If  two  roots  are  thus  affected,  the  tooth  had  better  be  extracted. 

The  use  of  local  anesthetics  is  not  advised.  To  further  poison 
the  tissues  by  actual  injection  when  they  are  already  in  a  low  state  of 
vitality  is  contraindicated,  and  the  slight  anesthesia  otherwise  in- 
duced is  too  often  obtained  only  at  the  expense  of  quite  as  much  pain  as 
the  careful  scaling  and  curetting  with  the  proper  instruments  would 
produce.  The  parts  not  being  anesthetized  serves  as  a  guide  to  the 
careful  operator  in  locating  the  pockets  when  the  surgical  treatment  can 
be  accomplished  with  a  minimum  amount  of  injury  to  the  soft  parts 


352 


PRACTICAL    DENTAL    THERAPEUTICS. 


involved.     If  care  and  judgment  is  exercised,  neither  the  pain  nor  the 
discomfort  is  as  great  as  might  naturally  be  supposed. 

After  the  surgical  treatment  is  completed,  the  prophylactic  treat- 
ment with  the  usual  instructions  should  be  given.  Patterson1  states  that 
"experience  has  taught  that  the  time  spent  in  smoothing  the  roots  is  well 
worth  the  endeavor,  for  the  rapidity  and  permanency  of  the  recovery  is 
greatly  enhanced,  and  the  operation  cannot  be  considered  com- 
pleted until  as  much  time  is  given  to  the  polishing  as  to  the  removal  of 
the  deposits." 


Fig.  21. 


Fig.  22. 


Fig.  21  shows  an  exposed  molar  root,  such  as  is  frequently  encountered  in  the  treat- 
ment of  pyorrhea  alveolaris. 

Fig.  22  shows  the  case  after  the  excision  of  the  root.  A,  excised  root;  B,  cavity 
after  removal. 


2.  Medicinal  Treatment. — The  medicinal  treatment  for  this  class 
of  cases  is  practically  the  same  as  for  the  preceding  class.  The  pockets 
should  be  washed  out  thoroughly  after  the  surgical  treatment. 
This  may  be  accomplished  with  either  the  spraying  apparatus  or  water 
syringe,  having  a  small  point  on  the  nozzle.  Iodin,  because  of  its 
penetrating  and  stimulating  property,  is  especially  efficacious  in  these 
bone  affections.  The  case  generally  yields  nicely  when  the  application 
of  the  local  astringent  remedy  is  made  at  intervals  of  two  or  three  days. 
The  time  of  making  the  subsequent  applications  should  gradually  be 
lengthened,  and  in  about  two  or  three  weeks  the  case  should  be  ready 
for  the  patient  to  care  for  themselves.  It  should  be  remembered  that 
in  this  class  of  cases  the  patient,  as  well  as  the  dentist,  is  confronted 
with  a  more  serious  proposition.  The  instruction,  therefore,  should 
be  explicit  and  the  progress  of  the  case  closely  watched. 

In  stubborn  pus  pockets  it  is  sometimes  necessary  to  thoroughly 
cauterize  the  area  involved  in  order  to  check  the  pus  formation.     For 

1  Johnson's  Operative  Dentistry,  p.  467. 


PYORRHEA   ALVEOLARIS.  353 

this  purpose  excellent  results  may  often  be  had  from  the  use  of  a  25  or 
50  per  cent,  solution  of  phenolsulphonic  acid.     This  is  a  valuable 

stimulating  agent,  and  may  be  applied  deep  down  into  the  pocket  with 
a  Dunn  drop  applicator;  on  general  principles,  however,  the  use  of 
acids  in  the  treatment  of  this  disease  is  contraindicated,  not  because 
they  will  not  assist  Nature  in  effecting  a  cure,  but  because  of  the  ex- 
treme sensitiveness  which  they  produce. 

Occasionally  the  pus  formation  will  persist  in  a  pocket  where  we 
are  reasonably  certain  that  the  ordinary  surgical  treatment  has  been 
thorough,  and  where  also  the  pocket  has  been  cauterized.  Here  we 
can  suspect  resorption  of  the  root  in  the  apical  area,  leaving  sharp, 
needle-like  points,  which  keeps  up  the  irritation.  In  these  cases  it  is 
necessary  to  amputate  the  root-end  or  extract  the  tooth.  The  author's 
experience  with  replantation  as  a  last  resort  in  the  cure  of  badly  affected 
teeth  in  pyorrheal  or  abscessed  conditions  has  not  been  encouraging. 
For  permanent  results  it  is  absolutely  essential  that  the  replanted  tooth 
be  held  firmly  in  position  by  some  permanent  appliance,  and  generally 
its  extraction  and  the  insertion  of  an  artificial  tooth  is  far  more  sanitary 
and  satisfactory.  It  is  not  a  question  here  of  what  a  dentist  can  do  by 
his  ingenuity  and  skill,  but  rather  a  question  of  what  is  best  for  the 
patient. 

Head,  of  Philadelphia,  has  recently  brought  forth  the  use  of  ammo- 
nium hydrogen  fluorid  as  a  tartar  solvent  in  the  treatment  of  pyorrhea 
alveolaris.  The  solution  which  he  recommends  is  made  as  follows: 
Commercial  hydrofluoric  acid  is  completely  neutralized  with  ammo- 
nium carbonate  and  ammonium  fluorid  formed  which  dissolves  in  the 
water  present.  This  solution  is  filtered,  and  as  such  has  little  chemic 
action  on  the  so-called  "tartar"  on  the  teeth.  To  make  the  more 
active  acid  salt  solution  the  ammonium  fluorid  solution  is  now  evapo- 
rated in  a  leaden  dish  to  one-half  of  its  original  bulk,  an  equal  amount 
of  hydrofluoric  acid  is  added,  and  the  whole  again  evaporated  to  one- 
half  of  its  bulk.  The  resulting  solution  is  ammonium  hydrogen  fluorid. 
Great  care  must  be  exercised  in  making  this  solution,  for  if  any  of  the 
hydrofluoric  acid  is  left  free,  its  action  would  produce  serious  results. 

Head  recommends  making  the  application  to  a  pyorrheal  pocket 
with  a  rubber  syringe  having  a  platinum  point  or  with  a  drop  appli- 
cator. The  claim  is  made  that  it  will  dissolve  the  deposit  without  any 
deleterious  effect  on  the  soft  tissues.  At  this  time  the  remedy  has 
not  been  sufficiently  tried  to  merit  further  discussion.  The  author 
again  desires  to  emphasize  the  precautions  to  be  observed  in  obtain- 
ing a  solution  of  ammonium  hydrogen  fluorid  free  from  uncombined 


354 


PRACTICAL    DENTAL    THERAPEUTICS. 


hydrofluoric  acid,  for  a  burn  from  this  acid  is  at  best  a  stubborn  con- 
dition to  treat,  especially  in  the  mouth  where  there  is  always  danger 
of  a  mixed  infection. 

The  raising  of  the  opsonic  index  has  been  suggested  as  a  means 
of  combating  the  disease,  as  has  also  the  use  of  a  specific  vaccine 
(Hecker).  The  efficacy  of  these  methods  have  not  been  sufficiently 
demonstrated  to  merit  a  discussion  in  a  work  on  "practical  thera- 
peutics" at  this  time.  It  is  to  be  hoped  the  true  cause  of  pyorrhea 
alveolaris  will  soon  be  discovered,  when  the  medicinal  treatment  can 


Fig.  23.  Fig.  24. 

Fig.  23  shows  the  retainer  in  wax  with  the  sprue  inserted  ready  to  be  invested  for 
casting. 

Fig.  24  shows  the  completed  appliance  set  on  the  model. 

DIRECTIONS  FOR  MAKING. 

A  modeling  compound  impression  is  taken  of  the  cutting  edge  and  upper  lingual 
third  of  the  teeth  to  be  included  in  the  appliance.  From  this  impression  a  model  is  made 
with  a  good  investment  material.  It  is  best  to  let  it  set  over  night,  when  the  modeling 
compound  can  be  removed  by  using  dry  heat.  Care  should  be  exercised  so  as  not  to  chip 
the  margins  of  the  investment  teeth.  On  this  model  the  retainer  can  be  made  in  wax  just 
as  it  is  desired  when  completed.  The  model  is  trimmed  so  it  will  enter  a  casting  flask, 
the  sprue  inserted  and  it  is  ready  for  investing  (Fig.  23).  After  casting,  it  is  finished  and 
set  in  the  usual  manner.     (Fig.  24.) 


be  instituted  along  more  rational  lines  or,  what  would  be  better,  to 
inaugurate  such  prophylactic  measures  that  the  disease  might  be 
prevented. 

In  our  present  state  of  knowledge  it  must  be  stated  that  too 
much  dependence  should  not  be  placed  upon  drugs,  for  at  this  time 
there  is  no  known  specific  for  the  cure  of  the  disease. 

Where  the  loss  of  tissues  has  been  extensive  and  the  teeth  are  so 
loose  as  to  interfere  with  their  usefulness  in  mastication,  the  correct 
treatment  necessarily  includes  the  making  of  mechanical  appliances 
for  their  support. 

3.  Mechanical  Treatment. — The  importance  of  what  the 
author  has  chosen  to  call  the  mechanical  treatment  of  the  disease 
under  consideration  has  previously  been  emphasized.  The  detailed 
descriptions  of  the  method  of  making  the  various  mechanical  appli- 
ances is  not  properly  included  in  a  work  of  this  character.     The  proper 


PYORRHEA  ALVEOLARIS.  355 

appliance  for  holding  loose  teeth  in  the  jaw  will  naturally  suggest 
itself  to  the  ingenious  dentist.  They  consist  of  a  combination  of  inlays, 
crowns  and  bridges,  the  so-called  splits,  and  various  retainers.  For 
the  benefit  of  the  beginner  a  splint  for  loose  teeth  which  need  not 
be  devitalized  is  illustrated  and  briefly  described  in  (Figs.  23,  24, 
and  25).  On  the  following  pages  the  reader  will  find  tigs.  26  to  38, 
inclusive,  with  descriptions  which  were  furnished  the  author  by 
Dr.  Lee  K.  Stewart,  of  Chicago,  and  explain  fully  his  method  of 
treating  the  conditions  under  consideration  from  the  mechanical 
view  point. 


Fig.  25  shows  loosened  lower  anterior  teeth,  temporarily  wired  with  a  26  gauge  platino- 
iridium  wire,  to  hold  the  teeth  during  the  scaling  process,  after  which  a  permanent  retainer, 
as  illustrated  in  Figs.  23  and  24,  was  adjusted. 

CLASS  III. 

In  considering  the  therapeutics  of  this  class  of  cases  from  the 
dental  viewpoint  it  can  be  stated  that  the  treatment  is  both  local  and 
general. 

1.  Local  Treatment. — The  local  treatment  involves  practically 
the  same  surgery,  drugs  and  remedies,  and  mechanical  appliances  as  in 
the  preceding  classes,  modified  only  to  meet  the  conditions  as  found. 
To  be  effective  and  permanent  the  treatment  by  the  dentist  must  be 
done  conjointly  with  the  general  treatment  by  the  physician  in  charge. 

2.  General  Treatment. — Whenever  the  local  condition  in  the 
mouth  seems  to  be  aggravated,  if  not  caused  by  some  of  the  systemic 
diseases  elsewhere  mentioned,  it  is  the  plain  duty  of  the  dentist  to 
refor  the  patient  to  their  family  physician  for  the  general  treatment. 
In  fact,  it  is  almost  useless  to  undertake  the  local  treatment  unless 
measures  are  simultaneously  instituted  for  the  correction  of  the  sys- 
temic disease;  but  when  the  physician  and  dentist  work  together  in 
harmony,  it  is  surprising  what  great  relief  can  be  given  the  patient 
by  the  proper  local  treatment,  for  the  mouth  in  many  instances  is  in 
a  hideous  condition. 

In  conclusion,  I  desire  to  state  that  it  is  a  pleasure  to  work  for 
pyorrheal  patients.  In  many  instances  they  have  been  informed  that 
nothing  could  be  done,  and  that  they  must  soon  lose  their  teeth; 
therefore,  in  most  cases,  they  appreciate  fully  your  every  effort. 


356 


PRACTICAL    DENTAL    THERAPEUTICS. 


Fig.  26  A. 


Fig.  26  B. 


Fig.  27  A 


Fig.  27  B. 


Fig.  28  A. 


Fig  28 B. 


Fig  29  A. 


Fig.  29  B. 


Fig.  29  C 


Fig.  30. 


Fig.  31 


Fig  32 


Fig.  33 


I'MiKRIli    \    .\I.\  I  "I   \RIS. 


357 


Fig.  35. 


Fig.  36. 


Fig.  37. 


Fig.  38. 


Fig.  26. — "A"  and  "B".  Loose  Teeth  from  which  the  pulps  have  been  removed, 
the  canals  filled,  prepared  for  insertion  of  soft  platinum  wire  and  ready  for  the  wax  pattern 
or  modeling  compound  impression. 

Fig.  27. — "A"  and  "B".  One  or  more  teeth  with  soft  platinum  wire  in  position. 
The  exposed  end  is  barbed  to  hold  either  in  the  wax  pattern  or  the  impression  material. 
The  operator  may  prepare  the  wax  model  for  casting  directly  upon  the  tooth,  or  upon  the 
models. 

Fig.  28. — "A"  and  "B".     Modeling  compound  impressions  of  one  or  more  teeth. 

Fig.  29. — "A",  "B"  and  "C".  Models  of  one  or  more  teeth  made  from  impressions, 
waxed  and  ready  for  investing  for  casting.  Notice  the  pin  has  been  placed  to  direct  the 
flow  of  gold  by  rather  than  at  the  model.     Models  made  of  equal  parts  of  plaster  and  silica. 

Fig.  30  — Double  wax  model  made  directly  upon  the  teeth  and  ready  for  investment. 

Fig.  31. — Method  of  investing. 

Fig.  32. — Two  castings  in  position  and  ready  for  the  impression.  Notice  the  exposed 
end  of  soft  platinum  wire  has  not  been  cut  off.  Do  not  attempt  to  assemble  more  than 
two  at  one  time,  and  take  the  impression  of  the  parts  ready  to  be  united  either  with  a  small 
piece  of  modeling  compound  or  just  a  little  plaster.  Fill  the  impression  with  ordinary 
soldering  investment,  separate  and  solder. 

Fig.  ^^. — Two  castings  soldered.  Continue  in  this  manner,  making  single,  double  or 
larger  castings,  either  from  models  or  by  carving  the  wax  upon  the  natural  tooth. 

Fig.  34. — Finished  case  with  pins  well  barbed.  Do  not  cut  barbs  opposite  each  other 
and  remember  the  exposed  ends  of  soft  platinum  wire  are  not  cut  off  until  case  is  ready 
for  the  final  polishing.  No  gold  should  be  noticeable  in  the  patient's  mouth.  The  larger 
barbs  will  prevent  a  tooth  that  has  been  shortened  from  dropping  below  the  others. 

Fig.  35. — A  case  with  loss  of  the  lateral  incisor. 

Fig.  36. — Retaining  appliances  replacing  lost  incisor.  Many  cases  present  where 
one  or  more  teeth  have  been  lost  and  the  others  very  loose.  This  appliance  will  support  the 
loose  ones  and  replace  the  lost  ones. 

Fig.  37. — Labial  view. 

Fig.  38. — Lingual  view. 

This  method  can  be  used  in  any  place  in  the  mouth  to  support  loose  teeth  and  to 
carry  bridged  ones. 

Where  it  is  desirable  to  retain  the  pulps,  use  one  or  two  short  soft  platinum  pins  in 
each  tooth  and  prepare  nearly  parallel  pits  as  far  away  from  the  pulp  as  possible.  Before 
placing  the  appliance,  barb  the  pins  well  and  undercut  the  cavities.     (L.  K.  Stewart.) 


NEURALGIA. 
GENERAL  CONSIDERATIONS. 

Neuralgia  is  not  a  disease  in  itself,  but  is  rather  a  manifestation  of 
a  disease  or  perverted  function.  It  may  be  denned  as  a  severe  paroxys- 
mal pain  in  the  area  of  distribution  of  a  nerve,  or  along  its  course; 
and,  according  to  Barrett,  true  neuralgic  pain  is  principally  confined  to 
the  afferent  nerves,  but  it  may  be  of  a  reflex  character  and  hence  have 
its  origin  in  the  efferent  or  motor  nerves.  The  neuralgias  which  gen- 
erally come  under  the  observation  of  the  dentist  are  chiefly  those 
manifested  in  the  area  of  distribution,  or  along  the  course  of  the  fifth 
cranial  nerve,  and  are  accordingly  called  facial,  trifacial,  and  trigeminal 
neuralgia.  This  includes  the  pains  arising  from  the  teeth  or  reflected 
to  them.  Marshall1  states  that  "the  conditions  which  are  productive 
of  neuralgia  are  many  and  varied,  and  consist  chiefly  of  diseases  which 
lower  the  vital  powers  of  the  system,  such  as  anemia,  or  those  which 
interfere  with  such  functions  as  the  circulation,  respiration,  digestion, 
assimilation,  secretion,  and  elimination;  the  presence  in  the  system  of 
abnormal  substances,  as  in  gout,  rheumatism,  diabetes,  malaria,  neph- 
ritis, chronic  pyemia,  syphilis,  and  metallic  poisoning;  local  condi- 
tions which  cause  reflex  peripheral  irritation,  such  as  diseases  of  the 
teeth,  eyes,  ears,  stomach,  uterus,  and  ovaries;  chronic  inflammation  of 
the  nerve  or  its  sheath;  pressure  from  abnormal  growths  within  the 
bony  canal  through  which  the  nerve-trunk  passes,  or  pressure  from 
tumors,  and  localized  anemia  or  congestion  of  nerves  or  nerve-centers. 
Neuralgia  may,  therefore,  be  the  result  of  an  actual  diseased  condition 
of  the  nerve,  as,  for  instance,  in  a  neuritis,  or  it  may  exist  with  no  dis- 
cernible structural  change  in  the  nerve-tissue  or  the  nerve-center." 
Women  are  especially  prone  to  neuralgia  during  the  period  of  the  so- 
called  "change  of  life.'! 

FACIAL  NEURALGIA. 

There  are  many  local  conditions  in  and  about  the  teeth  which 
cause  facial  neuralgia.     Chief  among  which  are: 
i.  Pulpitis. 
2.  Pulp  nodules,  partially  calcified  pulps,  and  secondary  dentin. 

1  Injuries  and  Surgical  Diseases  of  the  Face,  Mouth  and  Jaws. 

358 


NEURALGIA.  359 

3.  Pericementi: 

4.  Cementosis. 

5.  Deposits  on  the  roots  of  teeth. 

6.  Exposed  dentin  and  cementum. 

8.  Impacted  teeth. 

9.  Faulty  occlusion. 

THERAPEUTICS. 

The  first  essential  in  the  treatment  of  neuralgia  due  to  diseases  of 
the  teeth  is  to  ascertain  the  cause  and  remove  or  correct  it  if  possible. 
As  Harlan  says,  "the  dentist  should  consider  no  time  lost  in  an  en- 
deavor to  find  the  cause  of  facial  neuralgia."  It  is  essential  here,  as  in 
all  treatment  cases,  to  make  a  correct  diagnosis.  In  most  cases  the 
symptoms  are  of  the  subjective  variety  and  a  correct  diagnosis  is  often 
difficult  to  make.  Fortunately,  however,  by  means  of  skiagraphy 
many  of  the  conditions  mentioned  as  being  productive  of  facial  neu- 
ralgia may  be  positively  diagnosed.  Illustrations  of  several  of  these 
conditions  are  found  in  Figs.  39,  40,  41,  42,  43,  44,  45,  and  46.  The 
author  desires  to  emphasize  the  importance  of  ascertaining,  if  at  all 
possible,  the  cause  of  the  neuralgia,  for  upon  this  depends  largely 
the  method  of  applying  our  therapeutics.  With  the  cause  known, 
the  treatment  is  of  two  kinds — medicinal  and  surgical. 

I.  Medicinal  Treatment. — The  medicinal  treatment  of  facial 
neuralgia  may  be  subdivided  into  local  and  general. 

1.  Local  Treatment. — There  are  many  drugs  and  remedies 
which  act  favorably  upon  the  sensory  nerve-endings,  and  are  therefore 
efficacious  in  the  local  medicinal  treatment  of  this  disorder. 

The  author's  dental  liniment  mentioned  in  connection  with  non- 
septic  pericementitis  (p.  296)  will  often  give  excellent  results,  or  any  of 
the  following  remedies  may  be  prescribed: 

K  —  Mentholis,  gr.  xxx  (2.0  gm.) 

Alcoholis, 

Etheris,  aa     fovi  (24.0  c.c.) 

Chloroformi,  q.  s.  ad.     foiij  (90.0  c.c.) — M. 

Sig. — Apply  by  vigorous  rubbing  or  massage  over  the  area  of 
distribution  of  the  affected  nerve,  or  along  its  course. 

R — Camphorae  (gum),  5ij  (8.0  gm.) 

Tinctune  aconiti,  foj  (30.0  c.c.) 

Linimenti  saponis,  q.  s.  ad.     foiij  (90.0  c.c") — M. 
Si?. — Use  as  above. 


36° 


PRACTICAL   DENTAL   THERAPEUTICS. 


Fig.  39. — This  skiagraph,  taken  by  Ream,  shows  an  impacted  lower  third  molar, 
frequently  the  cause  of  facial  neuralgia. 


Fig.  42. 


Fig.  43. 


Fig.  40.  Fig.  41. 

Figs.  40,  41,  42  and  43  show  cementosed  roots,  the  cause  of  facial  neuralgia. 


Fig.  44. 


Fig.  45. 


fy    %&^j 


Fig.  46. 


Fig.  44  shows  a  lower  third  molar  coalesced  to  and  between  the  roots  of  the  lower 
second  molar. 

Fig.  45  shows  a  pulp  nodule  nearly  one-quarter  of  an  inch  long  which  fits  the  canal 
as  perfectly  as  a  pea  fits  the  pod.  The  tooth  for  years  had  carried  an  ill-adjusted  shell 
crown,  which  had  been  placed  without  devitalization  and  the  proper  trimming  of  the  root. 

Fig.  46  shows  various  size  pulp  nodules. 


\l  ITRALGIA.  361 

W.  H.  Truman  suggests  the  following: 

1$ — Camphors  (gum),  5j  (a.o  gm.) 

Etheris,  f3ij  (8.0  c.c.) 

Alcoholis,  f.lj  (30.0  c.c.) 

Chloroformi,  q.  s.  ad.     fSiij  (90.0  c.c.) — M. 
Sig. — Use  as  above. 

The  various  liniments  here  given  have  practically  the  same  thera- 
peutic effect-    that  of  a  sedative  upon  the  peripheral  sensory  nerves. 

In  cases  where  the  pain  comes  from  pericementitis  or  from  a 
developing  abscess  associated  with  the  upper  anterior  teeth,  it  may  be 
stopped  in  many  instances  like  magic  by  spraying  the  posterior  nares 
with  alcohol  and  water,  as  suggested  by  Keefe  (see  p.  307). 

Electricity  is  often  of  great  value.  Marshall  suggests  applying  the 
positive  pole  of  a  galvanic  battery  to  the  painful  spot,  when  a  current 
of  from  one  to  three  milliamperes  is  applied  from  two  to  five  minutes. 

2.  General  Treatment. — The  general  medicinal  treatment  in- 
volves the  administration  of  drugs  systemically.  If  certain  drugs  are 
indicated  for  the  correction  of  some  systemic  derangement  which  is 
causing  reflexly  the  facial  neuralgia,  as,  for  instance,  iron  compounds  in 
anemia,  quinin  in  malaria,  mercury  and  iodids  in  syphilis,  etc.,  they 
had  better  be  prescribed  by  the  family  physician.  Here  again  is  a  con- 
dition wherein  the  best  results  in  the  treatment  of  which  are  only 
obtained  by  both  the  family  dentist  and  physician  working  in  harmony. 
Cases  have  been  authentically  reported  where  physicians  had  treated 
patients  systemically  for  neuralgia  for  months  without  effect,  when 
ultimately  the  case  was  cured  instantly  by  the  dentist  in  relieving 
some  local  condition  about  the  teeth.  While,  on  the  other  hand,  den- 
tists have  been  known  to  keep  patients  suffering  for  months  in  an 
endeavor  to  locate  the  cause  about  the  mouth,  when  ultimately  the 
correction  of  some  systemic  trouble  cured  the  local  neuralgia. 

While  patients  should  be  referred  to  the  family  physician  for  the 
general  treatment  of  constitutional  diseases,  it  is  not  only  the  privilege 
but  the  plain  duty  of  dentists  to  prescribe  internal  drugs  for  the  relief 
of  pain  while  the  cause  of  the  neuralgia  is  being  searched  for  and  re- 
moved. It  is  true  that  this  involves  a  knowledge  of  drugs  and  their 
uses,  but  surely  this  is  not  too  much  to  expect  of  the  trained  dental 
practitioner  of  to-day.  The  classes  of  drugs  indicated  for  the  control 
of  pain  are  the  hypnotics  or  general  anodynes  or  analgesics.  Several 
prescriptions  are  here  given.  The  practitioner  can  select  the  one 
which  best  seems  to  suit  the  case  at  hand. 


362  PRACTICAL   DENTAL   THERAPEUTICS. 

ly — Pulveris  acetanilidi  comp.,  gr.  xx  (1.3  gm.) 

Fiat  chartula  No.  iv. 
Sig. — Take  one  power  every  hour  until  two  or  three  are  taken;  if 
not  relieved  after  two  or  three  hours,  take  the  remaining 
one  or  two. 

In  cases  of  neuralgia  of  rheumatic  origin  phenacetin  may  be  com- 
bined with  salophen  and  codein  sulphate  to  control  the  pain.  A 
prescription  follows: 

Py— Phenacetini, 

Salophen,  aa    gr.  xx  (1 .3  gm.) 

Codeinae  sulphatis,  gr.  j  (0.06  gm.) — M. 

Fiat  chartula  No.  iv. 
Sig. — Take  one  powder  every  two  hours. 

When  the  neuralgia  is  associated  with  nervous  headache  the 
following  prescription  may  be  given: 

1$ — Caffeinae  citratis,  gr.  xij  (0.8  gm.) 

Phenacetini,  5  ss  (2.0  gm.) — M. 

Fiat  chartula  No.  vj. 
Sig. — Take  one  powder  every  two  hours  until  relieved. 

Patients  occasionally  do  not  like  to  take  a  powder,  preferring  a  liquid 
preparation.  In  these  cases  we  can  prescribe  antipyrin  in  solution 
with  an  aqueous  vehicle,  for,  unlike  acetanilid  and  phenacetin,  this 
drug  is  soluble  in  water.  Sometimes  it  is  advisable  to  combine  the 
coal-tar  analgesics  with  a  bromid,  a  prescription  for  such  a  combination 
is  here  given: 

1$ — Antipyrini,  oss  (2.0  gm.) 

Sodii  bromidi,  5j  (4.0  gm.) 

Glycerini,  foss  (15.0  c.c.) 

Aquae  cinnamomi,  q.  s.  ad.     f§ij  (60.0  c.c.) — M. 

Sig. — Take  a  dessertspoonful  three  times  a  day,  and  oftener  if 
conditions  necessitate. 

Sometimes  the  coal-tar  analgesics  fail  to  produce  the  desired 
effect,  in  which  case  there  is  always  one  drug  that  can  be  relied  upon  to 
control  the  pain,  and  that  is  morphin.  This  drug  is  truly  indicated 
for  the  control  of  pain  from  whatever  source  and  may  be  given  here  in 
1/8  gr.  (0.008  gm.)  dose,  but  under  no  conditions  should  a  prescription 
be  written  for  the  drug.  Many  patients  are  in  the  habit  of  keeping  a 
copy  of  the  prescription,  and  when  the  remedy  works  well  in  a  certain 
case  they  often  get  the  prescription  refilled  for  themselves  or  friends  on 
the  least  provocation.  In  the  case  of  morphin  this  might  innocently 
lead  to  the  " habit."  Tablets  containing  the  usual  dose  (1/8  gr. 
—  0.008  gm.)  may  be  kept  on  hand,  and,  if  necessary,  two  such  tablets 


NEURALGIA.  363 

may  be  given  by  the  stomach  within  one-half  hour,  and  then  the 
patient  can  take  one  tablet  home — never  more  than  one,  if  two  have 
been  given  at  the  office,  which  can  be  taken  in  the  course  of  one  hour, 
if  not  relieved. 

When  the  patient  is  unable  to  sleep,  chloral  hydrate  or  butyl- 
chloral  hydrate  may  be  prescribed.  The  fifth  nerve  is  supposed  to  be 
especially  sensitive  to  the  influence  of  butyl-chloral  hydrate.  A  pre- 
scription follows: 

1^ — Butyl-chloralis  hydratis,  5j  (4.0  gm.) 

Fiat  capsula  No.  xij. 
Sig. — Take  one  capsule  every  three  hours  until  four  are  taken. 

In  cases  where  a  tonic  is  indicated,  as  in  anemia,  the  official 
syrup  or  glycerite  of  iron,  quinin,  and  strychnin  phosphate  may  be 
given.     A  prescription  for  the  syrup  follows: 

1^ — Syrupus  Ferri,  Quininae  et  Strych- 

ninae  phosphatis,  foiij  (90.0  c.c.) 

Sig. — Take  a  teaspoonful  in  water  before  meals. 

Where  the  neuralgia  is  of  malarial  origin,  quinin  is  indicated.  An  ex- 
cellent presciption  follows: 

»I$ — Quininae  Valerianatis,  gr.  xviij  (1.2  gm.) 

Extracti  Hyoscyami,  gr.  iv  (0.25  gm.) 

Extracti  Cinchonae,  gr.  viij  (0.5  gm.) — M. 

Fiat  capsula  No.  xij. 
Sig. — Take  one  capsule  before  meals  and  on  retiring. 

It  will  be  noticed  that  only  a  few  doses  have  been  prescribed  in 
any  of  the  above  prescriptions.  This  precaution  has  been  taken  be- 
cause some  of  these  patients  suffer  untold  agony;  in  fact,  they  may  be 
considered  temporarily  demented,  and  no  matter  how  specific  your 
verbal  and  written  directions  have  been,  they  may  ignore  your  direc- 
tions entirely  and  take  one  dose  after  another  on  the  general  principle 
that  "if  a  little  is  good,  more  is  better,"  until  they  have  taken  such  a 
quantity  as  may  result  in  an  overdose.  Therefore,  it  is  well  for  den- 
tists especially  to  be  careful  in  this  respect. 

II.  Surgical  Treatment. — The  surgical  treatment  often  involves 
major  surgery,  for  a  discussion  of  which  see  works  on  Oral  Surgery. 

TIC   DOULOUREUX. 

The  discussion  of  trifacial  neuralgia  would  indeed  be  incomplete 
without  at  least  brief  mention  of  tic  douloureux,  so  named  by  Trous- 

1  Taken  from  the  Dental  Cosmos. 


364  PRACTICAL   DENTAL   THERAPEUTICS. 

seau,  a  Frenchman.  The  condition  frequently  results  from  chronic  ir- 
ritation of  the  fifth  cranial  nerve.  The  pain  is  very  acute,  and  occurs 
in  distinct  paroxysms,  gradually  increasing  in  severity,  until  it  reaches  a 
climax,  when  it  quickly  subsides.  The  attack  may  occur  at  any  time 
and  is  provoked  by  speech,  laughing,  talking,  the  movement  of  a 
muscle,  etc.,  and  even  slight  noise  or  a  light  touch,  as  placing  the  hat  on 
the  head,  may  cause  a  paroxysm.  The  patient  lives  in  constant  dread 
of  an  attack. 

There  is  no  condition  which  elicits  greater  sympathy  than  this,  for 
the  experienced  physician  or  surgeon  realizes  that  little  can  be  done 
either  medicinally  or  surgically.  Materia  medica  has  been  exhausted 
in  search  of  a  cure,  and  surgery  affords  only  temporary  relief.  Patrick, 
Moyer,  and  others  report  favorably  upon  the  use  here  of  castor  oil. 
The  drug  is  first  pushed  to  almost  catharsis,  then  checking  the  dose, 
but  still  keeping  up  the  administration  of  the  drug.  Ultimately  the 
patient  can  take  large  quantities  of  castor  oil  without  the  cathartic 
effect. 

Stekoulis,  Schapiro,  Bennett,  Murphy,  and  others  have  injected 
osmic  acid  into  the  substance  of  the  affected  nerve  and  report  en- 
couraging results. 

Deep  injections  of  alcohol  in  the  region  of  the  orbit  of  the  affected 
nerve  for  the  relief  of  facial  neuralgia  has  been  recently  suggested. 
Patrick,  Moorehead,  Potts,  and  others  report  favorably  on  the  method. 
The  needle  generally  employed  is  one  adopted  by  Levy  and  Bandonin, 
which  is  graduated  in  centimeters  up  to  five.  The  alcohol  should  be 
about  75  per  cent.,  and  should  contain  a  very  small  amount  of  cocain. 
The  success  of  the  operation  will  be  indicated  by  a  slight  anesthesia 
over  the  parts  supplied  by  the  nerve.  Upon  the  slightest  return  of  the 
pain  the  operation  should  be  repeated,  after  which  relief  for  some 
months,  and  even  two  years  or  more,  may  be  expected  (Potts). 

On  the  whole,  it  may  be  stated  that  the  therapeutics  of  tic  doulou- 
reux is  discouraging  to  all  concerned.  Hirt  sums  up  the  conditions 
very  properly  when  he  says:  "Numerous  are  the  means  at  our  com- 
mand for  combating  tic  douloureux,  and  quite  as  numerous  are  the 
patients  who,  after  hundreds  of  unsuccessful  trials,  have  given  up  in 
despair  all  medicines  and  all  physicians." 

The  condition  has  not  been  thus  briefly  discussed  here  because 
of  the  likelihood  of  dentists  being  called  upon  to  treat  it,  but  rather 
because  they  are  often  called  in  consultation  on  the  case  to  aid  in  mak- 
ing a  correct  diagnosis. 


DISEASES  OF  THE  SOFT  TISSUES  OF  THE    MOUTH 
\<  )  I   DIRECTLY  ASS<  >CIATED  WITH  THE  TEETH. 

GENERAL  CONSIDERATIONS. 

In  this  general  group  will  be  considered  the  diseases  of  the  soft 
tissues  of  the  mouth  other  than  those  directly  associated  with  the 
teeth.  The  etiology  and  pathology  of  these  diseases  will  be  considered 
somewhat  more  fully  than  has  been  done  with  the  diseases  of  the  hard 
tissues  of  the  mouth  and  associated  structures,  for  the  reason  that 
dentists,  as  a  rule,  are  not  so  familiar  with  the  etiology  and  pathology 
of  the  diseases  under  consideration  here,  and  therefore  find  it  more 
difficult  to  differentiate  between  some  of  these  conditions  and  to 
make  a  correct  diagnosis — upon  which  the  successful  therapeutics  is 
based. 

The  mouth  is  a  hot-bed  for  many  kinds  of  bacteria,  and  is  therefore 
a  fruitful  field  for  diseases  of  almost  every  description. 

CANKER  SORES. 

Canker  sores  are  true  ulcers  and  are  among  the  more  common 
pathologic  conditions  of  the  soft  tissues  of  the  mouth.  They  are  sup- 
posed to  have  their  origin  primarily  in  the  mouth,  yet  Pusey  and  others 
believe  them  to  arise  from  trophic  disturbances.  The  author  has 
observed  that  women  are  peculiarly  susceptible  to  this  condition 
during  the  menstrual  period.  Some  women  have  canker  sores 
nearly  every  time  they  menstruate.  They  seem  to  be  associated  also 
with  gastro-intestinal  disturbances.  They  always  appear  suddenlv 
and  are  very  persistent  unless  given  suitable  treatment. 

Gilmer1  states  "that  they  most  commonly  occur  at  the  duplica- 
ture  of  the  mucosa  of  the  cheek  and  the  gums,  though  they  are  occa- 
sionally seen  on  the  floor  of  the  mouth  and  on  the  edges  and  under  the 
surfaces  of  the  tongue.  They  vary  in  size  from  that  of  a  grain  of 
wheat  to  that  of  a  small-sized  bean.  Their  depth  varies,  but  they  can 
never  be  considered  superficial.  1  heir  margins  are  rather  well-defined, 
but  not  so  markedly  as  are  chancrous  ulcers  of  similar  tissues,  neither 
are  they  so  irregular  as  are  lupus  ulcers  of  the  mouth.  The  mucosa 
for  a  quarter  to  a  half-inch  from  the  ulcer  is  of  a  deep  red  color.  The 
base  of  the  ulcer  is  overlaid  with  a  grayish-white  necrotic  covering, 
not  unlike  that  found  in  syphilitic  ulcers  in  the  mouth.  When  this 
'  Dental  Review,  Vol.  XXIII,  p.  496. 

365 


366  PRACTICAL  DENTAL   THERAPEUTICS. 

coating  is  removed,  a  granulating  surface  is  exposed,  which,  while 
extremely  sensitive  to  the  touch,  bleeds  but  slightly,  if  at  all.  These 
ulcers  are  so  distinctive  in  their  appearance  that  they  can  hardly  be 
mistaken  for  any  other  lesion." 

THERAPEUTICS. 

The  treatment  of  canker  sores  is  purely  local,  and  the  sooner  it  is 
instituted  the  less  persistent  the  ulcer  will  be.  The  necrotic  tissue 
may  be  carefully  removed  by  scraping,  or  cleansed  with  hydrogen 
dioxid,  after  which  the  raw  surface  should  be  dried  and  cauterized. 
They  generally  yield  nicely  to  one  application  of  silver  nitrate.  For 
this  purpose  a  10  per  cent,  solution  may  be  used;  a  20  per  cent, 
solution  of  argyrol  may  also  be  employed.  The  ulcer  being  acutely 
sensitive,  it  is  sometimes  better  to  use  95  per  cent,  phenol  as  the  cauter- 
izing agent.  The  analgesic  effect  thus  produced  is  often  of  value. 
The  mouth  should  be  kept  clean,  when  the  ulcers  usually  heal  with- 
out further  treatment. 

HERPES  LABIALIS. 

Herpes  labialis,  also  called  cold  sores  or  fever  sores,  have  a  similar 
origin  to  canker  sores.  They  are  of  a  herpetic  nature,  and  differ  in 
appearance  from  the  latter  principally  on  account  of  location  and  tissues 
involved.  They  occur  frequently  when  the  patient  is  suffering  from 
colds  or  during  convalescence  from  fevers,  hence  the  name.  Of  these 
Gilmer  says:  "herpes  of  the  lips  (herpes  labialis)  and  occasionally  of 
the  gums,  (herpes  gingivalis)  sometimes  follow  dental  operations  and 
cause  uneasiness  on  the  part  of  patient,  who  often  attributes  this  condi- 
tion to  infection  from  unclean  armamentarium  used  by  the  dentist, 
when,  in  truth,  the  patient  is  of  a  herpetic  diathesis,  and  under  such 
circumstances  a  slight  irritation  only,  in  such  locations,  being  sufficient 
to  excite  the  condition." 

THERAPEUTICS. 

The  treatment  of  cold-sores  consists  in  cleaning  the  part  with 
such  agents  as  hydrogen  dioxid  or  alcohol,  then  drying  and  making 
an  application  of  oil  of  cloves  or  spirit  of  camphor.  Either  of 
these  latters  agents  are  just  sufficiently  irritating  to  produce  stimulation 
of  the  cells  and  promote  healing.  If  the  cold-sore  is  large  and  liable 
to  crack  and  bleed  by  moving  the  lips,  it  can  be  kept  soft  and  pliable 
by  frequently  applying  euroform  paste,  or  immobilization  may  be  had 
by  applying  collodion.  In  the  latter  instance  the  part  should  be 
dusted  with  boric  acid  before  coating  with  collodion. 


SYPHILIS. 

It  is  important  that  every  dentist  be  familiar  with  the  characteris- 
tic symptoms  of  this  disease;  for  acquired  extragenital  syphilis  is 
primarily  manifested  in  and  about  the  soft  tissues  of  the  mouth, in 
what  is  known  as  the  initial  leison  or  hard  chancre,  which,  as  a  rule, 
develops  in  from  three  to  six  wreeks  after  infection.  The  chancre 
may  occur  in  various  locations — on  the  lips,  tips  of  the  tongue,  and 
the  pharynx — and  is  characteristic  of  what  is  known  as  primary 
sy»iJ>/oms. 

PRIMARY  SYPHILIS. 

The  infection  here  is  produced  by  direct  contact  of  the  syphi- 
litic virus  with  an  abraded  surface.  According  to  Logan,1  the 
principal  means  of  conveying  the  infection  extragenitally  is  through 
the  act  of  kissing,  drinking  from  a  broken  utensil,  the  use  of  a  pipe  or 
handkerchief  that  has  been  contaminated  with  the  virus,  or  from 
physicians'  or  dentists'  instruments  or  fingers  that  have  had  the  infected 
secretions  from  the  mouth  of  a  previous  patient  dried  upon  them. 

In  the  locations  found  in  the  mouth,  chancre  is  usually  single, 
though  it  may  be  multiple.  It  may  appear  first  as  a  papule,  the 
superficial  cells  of  which  finally  ulcerate,  with  necrosis  of  the  central 
area  quickly  following,  when  a  copious  and  highly  infectious  discharge 
comes  from  the  crater-like  opening  that  is  forming  on  the  tissues 
involved.  The  ulceration  occurs  in  from  four  to  ten  days  after  full 
development  of  the  chancre,  until  which  time  the  patient,  as  a  rule, 
experiences  very  little  pain  or  discomfort. 

Syphilis  is  a  more  common  disease  than  is  generally  supposed, 
and  inasmuch  as  the  characteristic  symptoms  of  the  most  infectious 
stage  of  the  disease  occur  primarily  in  the  mouth,  dentists  should  be 
ever  watchful  and  guard  against  the  infection  of  themselves  and  other 
patients.  Whenever  the  skin  on  the  hand  or  finger  of  the  dentist  is 
broken,  or  the  mucous  membrane  of  the  patient's  lip,  gum,  or  cheek 
is  punctured  by  an  instrument,  cauterization  of  the  part  should  at  once 
be  done. 

Therapeutics. — The  treatment  of  the  primary  symptoms  is 
unimportant.  In  fact,  unless  a  positive  diagnosis  can  be  made,  and  it 
'  Dental  Review,  Vol.  XXII,  p.  800. 

36/ 


368  PRACTICAL    DENTAL    THERAPEUTICS. 

is  often  difficult  to  be  certain  of  the  diagnosis  at  this  stage  of  the  disease, 
the  treatment  had  better  be  deferred  until  the  diagnosis  is  established 
by  the  manifestations  of  the  secondary  symptoms.  Long1  says  that* 
"positive  knowledge  upon  this  point  is  so  important,  in  view  of  the 
question  of  marriage,  of  prolonged  treatment,  and  of  personal  care 
in  spreading  of  infection,  that  the  matter  of  a  few  weeks  treatment 
may  be  properly  disregarded,  particularly  so  as  it  is  believed  that  noth- 
ing is  lost,  in  the  efficacy  of  treatment,  by  the  delay."  Oral  hygiene, 
of  course,  should  not  be  neglected. 

SECONDARY  SYPHILIS. 

The  manifestations  of  what  is  known  as  the  secondary  symptoms 
do  not  begin  to  appear  until  from  four  to  six  weeks  after  the  develop- 
ment of  the  hard  chancre.  If  no  treatment  has  been  instituted, 
eruptions  on  the  skin  usually  mark  the  beginning  of  this  stage,  and 
according  to  L.  Blake  Baldwin,  eruptions  are  frequently  found  on 
the  oral  mucous  membrane  quite  similar  to  those  upon  the  skin. 
These  eruptions  are  accompanied  by  fever,  sometimes  preceded  by  it. 
Simultaneous  with  the  eruptions  and  fever  characteristic  mucous 
patches  occur,  and  may  be  located  on  any  part  of  the  mucosa  of  the 
mouth,  regardless  of  whether  the  disease  originates  primarily  or 
secondarily  in  the  mouth.  The  presence  of  mucous  patches  is  a 
positive  sign  of  syphilis.  They  differ  from  canker  sores  in  that  they 
have  more  clearly  defined  margins  and  are  not  so  painful  to  the  touch, 
and  the  immediate  area  is  not  of  such  a  deep  red  color  (Gilmer). 
The  mucous  patches  are  exceedingly  infectious,  and  due  caution 
should  be  observed  not  to  carry  the  infection  from  one  patient  to 
another. 

Therapeutics. — Inasmuch  as  secondary  syphilis  is  manifested  in 
the  mouth  and  leaves  its  indelible  effects  upon  the  gums,  jaws,  and  ad- 
jacent structures,  mercury  is  the  one  drug  indicated  in  its  treatment, 
for  this  drug  has  a  selective  influence  upon  these  structures.  In  fact, 
mercury  is  a  specific  for  the  secondary  symptoms,  though  its  action,  as 
yet,  rests  purely  upon  an  empirical  basis.  It  is  not  even  known 
whether  the  action  of  the  drug  here  is  due  to  specific  toxicity  for  the 
syphilitic  virus  or  whether  it  is  simply  due  to  its  general  effects  upon 
metabolism.  The  former,  according  to  Sollmann,  seems  to  be  the  case. 
Mercury  is  not  only  palliative,  but  curative  in  this  stage — congenital 
as  well  as  acquired — whilst  its  administration  is  worse  than  useless  in 
the  first  and  third  stages. 

'  "  Dental  Materia  Mcdica  and  Therapeutics,"  p.  206. 


SYPHILIS.  369 

The  systemic  treatment,  of  course,  should  be  relegated  to  the 
family  physician.  Long'  very  properly  emphasizes  a  word  of  caution 
here.  He  says:  "It  may  fall  to  the  dentist  to  discover  a  case  of 
syphilis,  by  mouth  symptoms,  where  it  had  not  been  suspected,  but  he 
must  be  exceedingly  cautious  about  discussing  this  finding  with  the 
ient.  He  is  dealing  with  a  matter  for  which  he  has  not  been  con- 
sulted, and  in  any  suspicious  acts  or  words  of  his  lie  the  possibilities  of 
much  unpleasantness.  If  the  patient  be  an  innocent  wife,  a  statement 
of  his  discovery  might  produce  domestic  discord.  While  she  would 
have  a  most  serious  grievance,  entitling  her  to  our  pity,  a  revelation 
could  only  add  to  her  unhappiness.  A  suggestion  to  her  to  see  her 
family  physician  for  certain  general  conditions  that  you  find  evidence 
of.  would  be  the  proper  course;  and  even  this  advice  must  be  given 
tactfully,  without  arousing  suspicion  as  to  the  probabilities  in  the  case, 
for,  after  all,  a  mistaken  diagnosis  is  possible." 

The  preparations  of  mercury  most  frequently  prescribed  in 
syphilis  are  mercury  with  chalk,  and  compounds  like  bichlbrid,  bin- 
iodid,  and  protiodid.     The  ointments  are  used  by  inunction. 

An  accurate  and  positive  diagnosis  of  syphilis  should  always  be 
made  before  instituting  the  mercurial  treatment,  otherwise  disastrous 
results  are  almost  certain  to  follow.  In  a  recent  case  of  a  little  girl 
seven  years  old,  of  doubtful  syphilitic  history,  coming  under  the  ob- 
servation of  the  author,  a  sequestrum  was  removed  which  contained 
the  erupted  first  permanent  molar  and  the  crowns  of  the  nonerupted 
first  and  second  bicuspids.     The  case  terminated  fatally. 

Syphilographers  have  learned  from  sad  experience  that  mercury 
can  be  pushed  much  farther  without  producing  ptyalism,  if  the  mouth 
has  first  received  a  thorough  prophylactic  treatment.  This  includes 
the  removal  of  all  local  irritants,  such  as  hard  and  soft  deposits,  over- 
hanging fillings,  ill-fitting  crowns,  and  bridges.  Dentists  in  the  past 
have  hesitated  to  work  for  patients  who  were  known  to  have  the 
specific  disease  on  account  of  the  danger  of  self-infection,  and  thinking 
it  necessary  to  subsequently  discard  all  instruments  used.  Referring 
to  this  point,  Logan2  says :  "  These  syphilitic  individuals  can  be  cared  for 
with  impunity  if  the  operator  protects  his  hands  with  rubber  gloves  and 
then  scrubs  all  the  instruments  employed  and  boils  them  for  fifteen 
minutes.  If  this  plan  is  pursued,  there  is  no  need  of  such  absurd  action 
as  is  often  recommended — that  all  such  instruments  should  never  be 
used  again,  but  thrown  away. 

1  "  Dental  Materia  Medica  and  Therapeutics,"  p.  206. 
»  Dental  Rrsiru.\  Vol.  XXII,  p.  813. 

24 


370  PRACTICAL   DENTAL   THERAPEUTICS. 

TERTIARY  SYPHILIS. 

This  condition  may  be  prevented  if  proper  treatment  has  been 
previously  inaugurated.  In  cases  not  so  treated  the  tertiary  symptoms 
usually  occur  in  from  one-half  to  two  years  after  infection.  Gumma 
mark  the  third  stage  of  syphilis  and  first  appear  as  hard  bodies  or 
nodes  occurring  mostly  under  the  skin,  although  they  may  occur  under 
the  mucosa  of  the  mouth.  They  gradually  increase  in  size,  become 
more  superficial,  with  a  tendency  to  break  down  and  ulcerate.  When 
they  occur  in  the  region  of  the  hard  palate,  the  underlying  bone  fre- 
quently becomes  involved  and  extensive  necrosis  of  the  palate  and 
nasal  bones  follow.  Gilmer1  states  that  subperiosteal  gumma  are 
especially  destructive  to  bone,  and  reports  having  seen  cases  in  which 
the  soft  palate  also  was  completely  destroyed  from  ulceration  of  gumma 
in  that  locality.  Authorities  differ  in  regard  to  whether  the  lesions 
of  tertiary  syphilis  are  infectious.  They  are  probably  but  slightly 
so,  if  at  all;  however,  it  is  well  here  also  to  guard  against  spreading 
possible  infection. 

Therapeutics. — The  one  drug  indicated  in  the  treatment  of 
tertiary  syphilis  is  the  great  alterative,  potassium  iodid.  In  this  stage 
of  the  disease  the  efficacy  of  potassium  iodid  is  equal  to  that  of  mercury 
in  the  secondary  stage,  and  may  be  considered  a  specific.  The  systemic 
treatment  should  be  relegated  again  to  the  family  physician.  The 
initial  dose  of  the  drug  should  be  small,  and  the  amount  gradually  in- 
creased until  improvement  follows  or  symptoms  of  iodism  appear. 
For  permanent  results  it  is  necessary  to  continue  the  antisyphilitic 
treatment  from  six  months  to  a  year  or  more. 

The  question  of  whether  syphilis  can  be  cured  or  not  has  been  a 
debatable  one  in  the  past,  but  its  cure  is  no  longer  questioned  by  ex- 
perienced syphilographers.  Yet  it  may  be  safely  stated  that  few  cases 
are  ever  permanently  cured,  for  only  a  small  percentage  of  patients 
will  continue  the  treatment  sufficiently  long,  after  they  feel  perfectly 
well,  to  effect  a  permanent  cure. 

It  should  be  remembered  that  syphilis  stamps  its  indelible  effects 
upon  the  individual  thus  afflicted  in  almost  every  case,  and  that  any 
subsequent  infection,  like  in  alveolar  abscess  or  pyorrhea  alveolaris, 
is  likely  to  extensively  involve  the  osseous  structures,  and  yield  to  the 
ordinary  treatment  with  difficulty.  The  author  has  previously  re- 
ferred to  a  case  of  extensive  necrosis  following  slight  trauma  after  the  re- 
moval of  a  pulp,  by  pressure  anesthesia,  where  every  due  precaution  was 
taken  to  maintain  asepsis  in  performing  the  operation  (see  Fig.  7,  p.  3 16.) 

1  Dental  Review,  Vol.  XXIII,  p.  498. 


SYPHILIS.  371 

In  conclusion  here  I  desire  to  again  emphasize  the  fact  that  every 
dentist  should  so  school  himself  in  this  dreadful  disease  that  he  may  be 
able  to  at  once  recognize  its  various  manifestations.  When  in  doubt 
about  a  lesion  in  the  mouth,  it  is  always  better  for  dentists  to  as- 
sume that  it  is  specific  in  character,  and  take  every  due  precaution 
against  infecting  themselves  or  their  patients. 

\  1 1 •:  RCURIAL  STOMATITIS. 

Mercurial  stomatitis  is  a  condition  of  the  mouth  frequently  follow- 
ing the  administrations  of  mercury  and  its  compounds  for  the  treatment 
of  syphilis  and  other  conditions.  The  characteristic  symptoms,  known 
as  ptyalism,  and  the  treatment  of  the  condition  have  been  fully  con- 
sidered under  Mercury  (see  p.  184). 

TUBERCULOSIS. 

This  dreaded  disease  is  known  as  the  "great  white  plague,"  and 
is  occasionally  seen  on  the  mucosa  of  the  mouth.  Gilmer1  reports 
having  seen  three  cases,  one  of  the  tongue,  one  of  the  sublingual  sali- 
vary gland,  and  one  an  extensive  involvement,  including  a  part  of  the 
lips,  the  mucosa  of  the  cheek,  the  soft  palate,  the  tongue,  and  a  portion 
of  the  pharynx.  The  microscope  will  aid  in  definitely  determining 
tubercular  lesions  in  the  mouth,  as  well  as  in  other  parts  of  the  body. 
The  dentist  may  first  discover  the  lesion  and  aid  in  making  the  diagno- 
sis; but  the  treatment  had  better  be  done  by  the  general  medical  practi- 
tioner or  specialist,  for  the  cases  are  rare  and  no  definite  local  treatment 
has  thus  far  been  permanently  established.  It  may  be  stated,  however, 
that  various  forms  of  light  have  been  used  in  many  cases  with  favorable 
results  in  tubercular  and  similar  affections.  Where  there  is  bone  in- 
volvement Beck  reports  surprising  results  from  the  injection  of 
bismuth  paste. 

LEUCOPLAKIA  BUCCALIS. 

This  is  a  disease  of  the  mouth  and  tongue,  the  etiology  of  which 
is  as  yet  unknown.  A  large  percentage  of  the  cases  of  leucoplakia 
buccalis  give  a  previous  history  of  syphilis.  It  is,  therefore,  suspected 
that  the  latter  disease  has  a  causative  relation  to  leucoplakia,  though  no 
definite  evidence  in  this  respect  has  been  produced.  Gilmer,  who  has 
seen  a  large  number  of  cases,  is  of  this  opinion.     He*  says:  "Many  cases 

1  Dental  Review,  Vol.  XXIII,  p.  499. 
•  Dental  Review,  Vol.  XXIII,  p.  500. 


372  PRACTICAL    DENTAL    THERAPEUTICS. 

of  leucoplakia  buccalis  have  come  under  my  observation,  and,  with 
few  exceptions,  I  was  able  to  elicit  a  history  of  syphilis."  The  disease 
manifests  itself  upon  the  buccal  mucosa,  portions  of  the  gums  and  the 
dorsum  and  edges  of  the  tongue,  and  other  places.  There  appears, 
sharply  outlined,  whitish  or  silver-colored  points,  streaks,  bands,  or 
patches  of  irregular  shape,  either  flattened  or  slightly  elevated  above 
the  level  of  the  general  mucosa.  Ordinarily  they  simply  present  a 
roughened  surface  without  much  discomfort.  They  occur  almost 
exclusively  in  the  mouths  of  men  who  are  excessive  smokers.  The  con- 
dition, however,  should  not  be  mistaken  for  that  which  is  frequently 
seen  in  the  mouth  of  excessive  smokers,  especially  pipe  smokers,  where 
there  is  a  whitening  of  extensive  areas  of  the  tongue  or  hard  palate  or 
both.  Gilmer1  says  "  that  the  epithelium  of  the  smoker's  tongue  is  of  a 
brownish-white,  while  in  leucoplakia  the  patches  are  of  a  clear  white 
color. "  Leucoplakia  patches  are  very  characteristic,  no  other  condition 
of  the  mouth  presents  the  same  clinical  picture.  The  affection  is 
painless,  and  may  be  overlooked  by  the  patient  unless  it  becomes  com- 
plicated with  cancer.  It  has  been  observed  that  carcinoma  frequently 
has  its  beginning  in  the  site  of  an  old  leucoplakia  patch.  Since  this  is 
true,  an  early  diagnosis  should  be  made,  and  the  proper  treatment  in- 
stituted by  the  family  physician.  In  cases  of  known  syphilis  the 
antisyphilitic  treatment  would  be  indicated. 

ACTINOMYCOSIS. 

This  disease  is  common  among  the  lower  animals,  especially  cattle, 
and  is  known  as  lumpy-jaw.  The  disease  affects  the  lower  jaw  and 
cervical  glands,  and  cases  in  the  human  being  have  been  reported  by 
Brophy,  Bevan,  Zederbaum,  and  others.  It  is  produced  by  the  ray- 
fungus,  and  the  microscope  affords  a  positive  means  of  diagnosis. 

The  treatment  of  the  disease  had  better  be  carried  on  by  the 
medical  specialist,  as  it  is  so  rare  in  the  human  being  that  dentists  but 
seldom  see  the  condition.  The  use  of  copper  sulphate  in  this  disease 
has  been  previously  considered  (see  p.  76). 

ACUTE  ULCEROUS  GINGIVITIS. 

Acute  ulcerous  gingivitis  is  a  comparatively  rare  disease.  The 
author,  however,  has  seen  a  number  of  cases  in  the  mouths  of  children 
coming  to  the  college  infirmary  for  treatment  from  the  so-called 
"slum  districts"  of  Chicago.     This  may  have  been  a  coincidence,  but 

1  Dental  Review,  Vol.  XXIII,  p.   500. 


syphilis.  373 

I  have  never  observed  the  disease  in  well-kept  mouths.  It  may  be  re- 
garded as  a  filth  disease.  Gilmer1  well  describes  it  as  follows: 
"The  disease  attacks  simultaneously  the  gum  margins  on  their  buccal 
or  labial  aspect  about  two,  three,  or  possibly  four  teeth,  at  the  same 
time.  The  ulcers  come  suddenly,  quickly  destroying  the  gingiva- 
down  to  the  alveolar  process,  but  seemingly  not  invading  it,  exposing 
the  roots  of  the  teeth  to  this  extent.  The  margins  of  the  ulcers  are 
everted  crater-like,  somewhat  like  chancrous  ulcers.  The  base  of  the 
ulcers  are  overlaid  with  a  grayish-white  covering.  When  this  covering 
is  removed,  the  granulating  surface  bleeds  freely.  The  lymphatics 
related  to  the  area  become  enlarged,  and,  unlike  chancrous  lymphatic 
enlargements,  are  tender.  It  is  also  unlike  chancre  in  that  the  ulcers 
are  nearly  always  multiple  and  exceedingly  painful  to  touch.  Saliva- 
tion is  much  increased,  with  frequent  drooling,  the  breath  is  fetid,  and 
owing  to  the  absorption  of  toxic  elements,  there  is  a  slight  rise  in  tem- 
perature. The  contiguous  lingual  gingivae  become  reddened,  but  do 
not  participate  in  the  ulceration.  The  condition  has  been  mistaken 
for  syphilis." 

Therapeutics. — The  ordinary  local  remedies  used  for  somewhat 
similar  conditions  are  of  little  value  here  unless  systemic  treatment  is 
simultaneously  instituted.  Calomel  is  the  drug  to  give  internally.  A 
prescription  for  which  follows: 

I£ — Hydrargyri  chloridi  mitis,  gr.  ij  (0.13  gm.) 

Sodii  bicarbonatis,  5j  (4.0  gm.) — M. 

Fiat  chartula  No.  xx. 
Sig. — Take  one  powder  every  two  or  three  hours. 

The  local  treatment  consists  in  cleansing  the  ulcer  with  such  agents 
as  hydrogen  dioxid,  drying  the  part  and  applying  a  10  per  cent,  solution 
of  silver  nitrate  or  a  20  per  cent,  solution  of  argyrol.  If  the  ulceration 
is  checked,  complete  restoration  of  the  gum  tissue  by  granulation 
follows. 

GONORRHEA. 

According  to  Burchard-Inglis,  undoubted  cases  of  oral  infection 
by  the  specific  germ  of  gonorrhea  (gonococcus)  have  occurred.  The 
author  has  seen  at  least  one  such  case.  The  mucosa  of  the  cheeks, 
gums,  tongue,  and  even  of  the  hard  and  soft  palate  may  undergo 
intense  suppuration.  Mouth  hygiene  and  the  systemic  treatment  of 
the  constitutional  trouble  cures  the  case. 

1  Denial  Review,  Vol.  XXIII,  p.  501. 


374  PRACTICAL   DENTAL   THERAPEUTICS. 

There  are  a  variety  of  tumors  and  other  diseases  which  manifest 
themselves  in  the  mouth,  involving  both  the  soft  and  osseous  structures, 
for  the  diagnosis  and  treatment  of  which  see  works  on  Oral  Pathology 
and  Surgery.  The  more  common  of  the  diseases  of  the  soft  tissues  of 
the  mouth  and  their  treatment  have  been  thus  briefly  considered  here 
with  the  hope  of  stimulating  a  greater  interest  in  this  phase  of  mouth 
diseases. 


DENTAL  STERILIZATION. 

GENERAL  CONSIDERATIONS. 

Throughout  this  work  the  author  has  endeavored  to  emphasize  the 
importance  of  dental  sterilization.  The  methods  and  means  of  steriliz- 
ing tooth-structure  and  the  field  of  operation  have  been  fully  discussed 
in  the  description  of  the  various  operations  which  are  performed  in  and 
about  the  mouth;  but  while  the  importance  of  having  the  instruments 
sterile  has  been  repeatedly  mentioned,  the  means  of  sterilizing  the 
same  has  not  been  previously  discussed.  The  importance  of  personal 
cleanliness  on  the  part  of  the  dentist  and  of  his  office  armamen- 
tarium is  of  course  understood  and  need  not  be  considered  here. 

A  principle  in  surgery  is  to  avoid  the  presence  of  germs.  This 
means  that  the  instruments  used  must  be  sterile,  as  well  as  the  field  of 
operation  and  the  operator's  hands.  The  same  principle  holds  true  in 
dental  as  well  as  in  general  surgery. 

There  are  many  practical  devices  on  the  market  for  the  sterilization 
of  instruments.  By  practical  here  we  take  into  consideration  the  con- 
venience and  the  expense.  Any  apparatus  for  this  purpose  must  be 
convenient  to  use  and  no  reasonable  amount  of  expense  should  deter 
dentists  from  accomplishing  this  end. 

It  is  to  be  regretted  that  many  of  our  most  potent  disinfectants, 
such  as  formaldehyd,  mercuric  chlorid,  etc.,  while  excellent  for  the 
sterilization  of  the  hands  and  the  site  of  operation,  cannot  be  used  for 
the  sterilization  of  metal  instruments,  on  account  of  the  agent  acting 
upon  the  metal. 

A  Method  for  Sterilizing  Instruments. — In  late  years  the 
author  relies  largely  upon  moist  heat.  The  method  used  is  here  given: 
The  instruments  are  first  brushed  with  a  stiff  brush  to  remove  whatever 
debris  may  be  present,  after  which  they  are  immersed  in  boiling  water 
for  about  two  minutes;  they  are  then  transferred  to  a  10  per  cent. 
solution  of  formalin,  to  which  solution  about  5  per  cent,  of  borax  has 
been  added.  After  being  in  this  solution  for  about  two  minute?,  they 
are  again  rinsed  in  the  boiling  water,  carefully  dried,  and  placed  in 
their  proper  places  in  the  cabinet.  In  cases  of  questionable  specific 
infection,  the  instruments  should  be  boiled  for  at  least  fifteen  minutes. 
Sodium  carbonate  or  borax  should  be  added  to  the  water  to  prevent 
rusting  of  the  instruments. 

375 


376  PRACTICAL   DENTAL    THERAPEUTICS. 

If  the  instruments  are  thoroughly  dried  they  can  be  kept  from 
tarnishing  and  rusting  to  a  marked  degree  by  having  calcium  chlorid  in 
the  cabinet  near  the  instrument  tray.  The  agent  should  be  in  a  small 
glass  container  without  a  top.  Calcium  chlorid  is  highly  deliquescent 
and  readily  absorbs  the  moisture  in  the  air.  It  should  be  replenished 
every  few  days  or  whenever  it  has  completely  liquefied.  This  pre- 
caution is  of  special  value  during  the  damp  days  of  summer-time 
when  the  instruments  are  more  liable  to  rust. 


INDEX. 


ABSCESS,  alveolar,  305,  309 
^*     acute,  305 

question  of  extraction  in,  308 

treatment  of,  305 
chronic,  309 

treatment    of,    without    sinus, 

3°9 
treatment  of,  with  sinus,  311, 
31a 
complications,  311,  313 
in    deciduous    teeth,    treatment 

of,  320 
pericemental,  322 
Absorbent  cotton,  18 
Abstracts,  14 
Acacia,    i  i  3 

Acetanilid,  137 

poisoning  and  treatment,  137 
Acetozone,  85 
Acetphenetidin,  138 
Acid,  organic,  5 

acetic,  92 

glacial,  92 
benzoic,  41 
boric,  40 
gallic,  70 
hydrochloric,  91 
hydrofluoric,  99 

treatment  of  poisoning,  99 

lactic,  93 

monochloracetic,  93 
.    nitric,  90 

nitrohydrochloric,  91 

oxalic,  86 

phenolsulphonic,  89 

phosphoric,  177 

salicylic,  42 

sulphuric,  89 
aromatic,  89 

sulphurous,  88 

tannic,  68 

trichloracetic,  93 
A^  -  mite,  106 

poisoning  by,  106 

treatment  of,  107 
Actinomycosis,  372 
Action,  physiologic,  2 

of  salt  solutions,  204 
Active  principle  of  drugs,  4 
Actual  cautery,  99 
Acute  intoxication  by  alcohol,  158 

ulcerous  gingivitis,  372 
Adenphrin,  73 
Administration  of  drugs,  19 


Adrenalin,  73 

chlorid    in    pressure    anesthesia, 
objections  to,  283 
Age,  modifying  drug  action,  26 
Alcohol,  1  56 

poisoning  and  treatment,  1  58 
Alkaloids,  4 

artificial,  5 
Allspice,  227 
Aloes,  199 
Alphozone,  86 
Alteratives,  28,  171 
Althea,  115 
Alum,  74 
Ammonia,  160 

poisoning  and  treatment,  160 
Ammonium  bromid,  145 

carbonate,  161 

chlorid,  222 
Amyl  nitrite,  163 

poisoning  and  treatment,  164 
Amylum,  no 
Analgesics,  28,  118 
Anesthetics,  28,  118 

local,  118 

general,  131 
Anesthetization  of  pulps,  276 
Anise,  227 
Anodynes,  28,  118 
Antacids,  27,  34 
Antagonism  of  drugs,  258 
Antagonists,  28 
Anthelmintics,  28 
Antifebrin,  137 
Antimony    and    potassium    tartrate, 

221 
Antipyretics,  28,  136 
Antipyrin,  136 
Antiseptics,  28,  38 

solution  of,  40,  253,  349 
Antispasmodics,  29 
Antrum  of  Highmore,  335 

diseases  of,  335 

involvement    from    abscessed 
teeth,  318 

treatment  of,  336 
Apomorphin,  219 

Apothecaries'  weight  and  measure,  240 
Approximate  fluid  measures,  241 
A  qua?,  8 
Aqua  regia,  qi 
Argentum,  80 
Argyrol,  82 
Anstol,  >j 


377 


178 


INDEX. 


Arnica,  57 
Arsenical  paste,  285 

fiber,  286 
Arsenic  trioxid,  94,  190 

poisoning  by,  94 
local,  95,  291 
systemic,  95 

treatment  of,  95,  96 
Arsenum,  190 
Artificial  respiration,  124 

Sylvester's  method,  124 
Aspirin,  44 
Astringents,  29,  67 
Atropin,  166 

poisoning  and  treatment,  166 
Avoirdupois  weight,  240 

DANDAGES,  19 

*-*  plaster-of-Paris,  19 

Bark,  7 

Beck's  paste,  80 

Belladonna,  165 

Betanaphthol,  55 

Bismuth  subnitrate,  80 

Black  pepper,  225 

Black's  1-2-3,  47 

Blaud's  pills,  174 

Bleachers,  29,  83 

Bleaching  teeth,  329 

with  sodium  dioxid,  330 
with     25     per     cent,     hydrogen 
dioxid,  333 

Blue  ointment,  183 
vitriol,  76 

Bone    involvement,    from    abscesses, 
316,  317 

Borax,  36,  41 

Borism,  40 

Bromids,  144 

Brucin,  1  54 

Buds,  7 

Butyl-chloral  hydrate,  142 

pAFFEIN,  161 
^  citrate,  161 
Calcium  carbonate,  34 

chlorid,  79 

hydroxid,  solution  of,  3  5 

hypophosphite,  179 

phosphate  precipitated,  178 

sulphid,  crude,  193 
Calendula,  56 
Calomel,  186 
Calx  sulphurata,  193 
Calyx,  7 
Camphor,  107 
Camphors,  5 
Cane-sugar,  231 
Canker  sores,  365 

treatment  of,  366 
Cannabis  indica,  152 
Cantharides,  105 

poisoning  and  treatment,   105 
Capping  the  pulp,  271 
Capsicum,   ror 

plaster,  102 
Caraway,  227 


Carbohydrates,  4 

Carbon,  56 

Cardamom,  226 

Cardiac  stimulants,  1 54 

Carminatives,  29,  224 

Carron  oil,  3  5 

Cascara  sagrada,  197 

Castile  soap,  37 

Castor  oil,  200 

Cataphoresis,  24,  236,  264,  284 

Cathartics,  29,  196 

Caustic  potash,  98 

soda,  98 

pyrozone,  85 
Caustics,  31,  88 

in    treatment    of    hypersensitive 
dentin,  264 
Cereates,  17 
Chalk,  34 

Charcoal,  animal  and  wood,  56 
Chinosol,  66 
Chloral,  141 
Chloretone,  130 
Chlorin,  86 
Chlorinated  lime,  87 

soda,  solution  of,  87 
Chloroform,  134 

indications  and  contraindications 

*35 
Chloropercha,  116 
Chromic  trioxid,  96 
Chronic  alcoholism,  158 
Cinchona,  139 
Cinchonism,  140 
Cinnamic  aldehyd,  46 
Coca,  120 
Cocain,  121 

history  of,  122 

hydrochlorid,  121 

habit,  125 

poisoning  and  treatment,  123 
Cod-liver  oil,  180 
Codein,  147 
Cold,  233 

in    treatment    of    hypersensitive 
dentin,  263 

sores,  treatment  of,  366 
Collodion,  115 
Collodions,  10 
Colycynth,  209 
Complications  of  pulp  removal,  288 

in  treating  putrescent  pulps,  302 

of  alveolar  abscesses,  313 
Compressed  air,  234 
Confections,  1  5 
Copper  oxid,  76 

sulphate,  76 
Corolla,  7 
Coriander,  228 
Corm,  6 

Corrosive  sublimate,  187 
Cosmolin,  112 
Cotton,  absorbent,  18 
Counterirritants,  31,  100 
Cream  of  tartar,  212 
Creosote,  62 
Cresol,  61 


I\M.\. 


379 


Croton  oil,  208 
Cumulative  effect,  25 

iy;.\l>I.Y  NIGHTSHADE,  165 
*^     Deo  id  ions,  1  a 
Demulcents,  30,  10S 

tal  liniment,  107,  296 

sterilization,  375 
I  dentifrices,  30,  -  ja 
I  denuded  root  end,  3 1 4 

rants,  30,  38 

1  devitalization  of  pu 
Dialysed  iron,  1 74,  287 
1  tiaphoretics,  30,  2 17 

ints,  194 
Digitalis,  162 

poisoning  and  treatment,  163 
Discolored  teeth,  327 

ofectants,  30,  38 
1  dispensatory,  3 

•sing  of  pus  in  abscess  cavity,  312 

ilution,  definition  of,  3 
I  Sureties,  30,  211 
Dobell's  solution,  253 
Donovan's  solution,  190 
Dosage,  modifying  drug  action,  25 
Dover's  powder,  147,  220 
Drastics,  20,  196 
Dressings,  antiseptic,  19 
Drugs,  administration  of,  20 

definition  of,  1 

derivation  of,  4 

pCHAFOLTA,  192 
*-*     Echinacea,   [92 
hysiologic,  2 

therapeutic,  2 
Effervescent  salts,  1  5 
Electricity,  236 
Elixirs,   10 
Emetics,  30,  218 
Emollients,  31,  88 
Emulsions,  1 1 
Bncystment  of  root,  3  1  6 
Epidermic   method   of   administering 

drugs,  23 
Epsom  salt,  203 

Equivalents  of  apothecaries'  in  metric 
weights  and  measures,  244 

'  •  7  ' 

irotics,  3r,  88 

in    treatment    of    hypersensitive 
dentin,  264 
Essential  oils,   5 

group  of,  as  antiseptics,  45 
Ether,  132 

contraindication,  133 

spray,  120 
Ethyl  alcohol,  156 

bromid,  135 

chlorid,  119 
Eucain,  129 

alpha,  129 

beta,    1  20 

hydrochlorid,  120 
Eucalyptol,  48 

compound,  49,  294 


Bucapercha  compound,  1 16 
Bugenol,  47 
Buroform  paste,  54 

iphen,  53 

1  ptii  ma)  1  a  c  1  if  pulp  exposun 

ision  of  root,  318 
Expectorants,  31,  221 
Exposed  pulps,  treatment  of,  270 
Extensive    necrosis,    from   abscesses, 

316 
Extracts,   1  1 

PATS,  s 

1       Fennel,  228 
Ferric  chlorid,  173 

hydroxid,  175 

with  magnesia,  1  7  5 
Ferrous  carbonate,  174 

hypophosphite,  175 

iodid,  175 

sulphate,  172 

subsulphate,  173 
Ferrum,  171 
Fig,  198 
Filling  root  canals,  324 

large  canals,  325 

small  canals,  325 
Fixed  oils  and  fats,  5 
Flavoring  agents,  228 
Flaxseed,  1 1 1 
Flower,  7 
Fluid  extracts,  13 
Fomentations,  18 
Foods,  32 

Formaldehyd,  63 
Formalin,  63 
Formocresol,  64 

prescription  for,  301 
Formol,  63 

Fowler's  solution,  190 
Foxglove,  162 
Fruit,  7 
Fuller's  earth,  117 

pAMBOGE,  209 

^      Gastric  stimulants,  167 

Gauzes,  19 

Gelsemium,  169 

General    anodynes    or    analgesics    in 

treatment  of  hypersensitive 

dentin,  268 
Gentian,   167 
Germicides,  30,  38 
Ginger,  225 
Glauber's  salt,  206 
Glonoin,  165 
Glucosids,  5 
Glycerin,  109 
Glycerites,  10 
Glycyrrhiza,  1 14 
Gold  and  sodium  chlorid,  104 
Golden  Seal,  7  2 
Gonorrheal  stomatitis,  373 
Green  vitriol,   172 
Gregory's  powder,  202 
Guaiacol,  62 
Gum  arabic,  1 13 


38o 


INDEX. 


Gums,  5 
Gutta-percha,  1 1 6 

LJABIT,  modifying  drug  action,  24 
**     Hamamelis,  71 
Heat,  67,  101,  232 

in  treatment  of  hypersensitive 
dentin,  262 
Hematics,  32,  171 
Hematoxylon,  71 
Hemophilia,  79 
Hemorrhage  after  pulp  removal,  283 

control  of,  280 
Hemostatics,  33,  67 
Henbane,  151 
Herb,  6 

Herpes  labialis,  366 
Honey,  198 
Honeys,  10 
Hydragogues,  29,  196 
Hydrastis,  72 
Hydrated  chloral,  141 
Hydrogen  dioxid,  64,  85 

25  per  cent,  solution  of,  65,  85 
Hygienic  remedies,  2 
Hyoscyamus,  151 
Hypersensitive  dentin,  treatment  of, 

261 
Hypodermic  method,  20 

factors  to  be  remembered,  2 1 

syringe,  22 

technic  of  injection,  22 

where  indicated,  21 

ICE,  120 

1     Idiosyncrasy,  2  5 

Imponderable  remedies,  2 

Incompatibility,  256 

Indian  hemp,  152 

Indications    for    removing    pulps    in 

pyorrhea  alveolaris,  3  50 
Infusions,  12 
Inhalation  of  drugs,  24 
Intravenous  method  of  administering 

drugs,  23 
Inunction,  23 
Iodids,  182 

ammonium,  182 
potassium,  181 
sodium,  182 
strontium,  182 
Iodin,  51 
Iodism,  53,  182 
Iodoform,  52 
Iodol,  52 
Ipecac,  220 
Iron,  171 

by  hydrogen,  174 
compounds  of,  172 
carbonate,  174 
chlorid,  173 
hyposphosphite,  175 
iodid,  175 
sulphate,  172 
subsulphate,  173 
Irritants,  31,  100 
Isotonic  solution,  204 
hyper,  205 
hypo,  205 


TABORANDI,  217 
*-*     Jalap,  209 
Juice,  7 

l/"AOLIN,  117 
**•      Kelene,  119 
Krameria,  70 
Kresamin,  67 

T  ABARRAQUE'S  solution,  87 
^      Lanolin,  112 
Laudanum,  147 
Laughing  gas,  131 
Lavender,  230 
Laxatives,  29,  196 
Lead  acetate,  75 

poisoning  by,  7  5 
Leaves,  7 
Lemon,  228 

Leucoplakia  buccalis,  371 
Liber,  7 

Licorice  root,  114 
Light,  234 

in    treatment    of    hypersensitive 
dentin,  263 
Light  magnesia,  37 
Lime  water,  35 
Liniments,  1 1 

for  dentists'  use,  107,  254 
Linseed,  1 1 1 
Liquor  antisepticus,  40 
Liquors,  8 
Lithium  benzoate,  216 

carbonate,  215 

citrate,  216 
Local  anesthetic  solution,  278 

anodynes     or    local    anesthetics 
in  treatment  of  hypersensi- 
tive dentin,  265 
Logan- Buckley  set  of  scalers,  344 

description  of  uses,  345 
Logwood,  7 1 
Lozenges,  1 5 
Lugol's  solution,  181 

prescription  for,  297 
Lunar  caustic,  81 
Lysol,  61 

1VIACE-  225 

1V1      Magnesium  citrate,  207 

oxid,  37 

sulphate,  203 

Malt,  195 

Malted  liquors,  1  57 

Mandrake,  210 

Manna,  198 

Marshmallow,  115 

Massage,  237 

Masses,  16 

Materia  medica,  definition  of,  1 

May  apple,  210 

Mechanical  remedies,  2 

Medical  Latin,  2  50 

Medicated  dressings,  19 

gauzes,  19 
Medicines,  definition  of,  t 

classification  of,  27 
Menthol,  50 


INDKX. 


38l 


Mercurol,  189 
Mercury,  183 

compounds  of,  185 

mercuric  chloria,  67,  187 
mercurou8  chlorid,  180 
iodid  ired),  188 
iodid  (yellow),   1  89 
mercury  biniodid,  188 
protiodid,  189 
objections  to  use  in  the  mouth 
by  homeopathic  physicians, 

185 

treatment  of  poisoning  by,  184 
Mercurial  stomatitis,  371 
Methods  of  bleaching  teeth,  329 
Metric  system,  241 
Metrology,  239 
Miscellaneous  compounds,  6 
Mixtures,  1  1 
Monsel's  solution,  173 

salt,  173 
Morphin,  147 
Mouth,  administering  drugs  by,  20 

washes,  253 
Mucilages,  11 
Mustard,  black,  102 

white,  102 
Mydriatic,  31 
Myotics,  32 
Myrrh,  57 
Myrtol,  223 

MARCOTICS,  32,  146 

^      National  formulary,  N.  F.,  4 

Xeuralgia,  358 

facial,  358 

treatment  of,  359 

tic  douloureux,  363 
treatment  of,  364 
Neurocain,  128 
Neutral  principles,  5 
Nicotin,  153 
Nitroglycerin,  165 
Nitrous  oxid,  131 
Normal  saline  solution,  169 
Nosophen,  53 

Novocain  hydrochlorid,  129 
Nutmeg,  225 
Nux  vomica,  1 54 

poisoning  and  treatment,  155 

("ML  of  cajuput,  46 
^     of  cinnamon,  46 

of  cloves,  47 

of  eucalyptus,  48 

of  morrhuae  (cod-liver),  180 

of  myrtle,  223 

of  peppermint,  49 

of  thyme,  50 

of  tigli  (croton),  208 

of  turpentine,  103 

olive,  in 

ricini  (castor),  200 
Oils,  fixed,  5 

volatile,  5 
Ointments,  17 
Oleates,  10 


< lleoresins,  14 

<  Ipium,  1 46 

conditions   modifying  action   of, 

'■Is 
contraindications,  1  50 

;  oning  and  treatment,   149 
'  >r;inge.  229 

<  Organic  acids.  5 
Orthoform,  130 
Osmic  acid,  97 

(  >smium  tetroxid,  97 
( )vary,  7 

(  ixidizing  agents,  83 
(  >xygen,  58 
Ozone,  58 

DANCREATIN,  195 

*        Papain,  196 

Papers,  18 

Paraffin,  113 

Parts  of  a  prescription,  247 

of  plants  used  for  drugs,  6 
Paraform,  63 
Paraformaldehyd,  63 
Paraldehyd,  143 
Paregoric,  107,  147 
Pathologic  conditions  modifying  drug 

action,  26 
Pearson's  solution,  190 
Pepper,  black,  225 
Pepsin,  194 

Percentage  in  solutions,  244 
Pericarp,  7 

Pericementitis,  nonseptic,  293 
causes  of,  293 
treatment  of,  295 

septic,  293,  305 
treatment  of,  305 
Peruvian  bark,  139 
Petroleum,  1 1 2 

liquid,  112 
Pharmaceutic  preparations,  7 
Pharmacodynamics,  definition  of,  1 
Pharmacologic  remedies,  2 
Pharmacology,  definition  of,  1 
Pharmacopeia,  U.  S.,  3 
Pharmacy,  definition  of,  3 
Phenacetin,  138 
Phenol,  58 

compound,  51 

poisoning  and  treatment,  59 
Phenyl   salicylate,    43 
Phosphorus,  176 

poisoning  and  treatment,  176 
Physical  agents  in  the  treatment  of 

hypersensitive  dentin,  262 
Physiologic  action,  2 

effect,  2 
Pills,  16 

Blaud's,  174 

compound  cathartic,  186 

compound  vegetable,  210 
Pilocarpus,  2 1 7 
Pistils,  7 

Plaster-of-Paris  bandages,  19 
Plasters,  18 
Podophyllum,  210 


382 


INDEX. 


Poison,  definition  of,  3 

Pollen,  7 

Potassium  acetate,  213 

and  sodium,  97 
tartrate,  207 

bicarbonate,  212 

bitartrate,  212 

bromid,  144 

carbonate,  212 

chlorate,  214 

citrate,  212 

dichromate,  97 

hydroxid,  98 

treatment  of  poisoning  by,  99 

iodid,  181 

nitrate,  215 

permanganate,  66 
Powders,  1 5 
Practical  prescriptions,   examples  of, 

252 
Precipitated  calcium  phosphate,  178 

carbonate,  34 
Preparations,  pharmaceutic,  7 
Prescription-writing,  246 
Pressure  anesthesia,  276 
Products  of  pulp  decomposition,  299 
Prophylactic  remedies,  2 
Protargol,  83 
Protectives,  109 
Prune,  198 

Prunus  virginiana,  168 
Ptyalism,  184 
Pulp  calcification,  290 

capping,  271 

decomposition,  299 

nodules,  290 

removal,  275 

anesthetization  method,  276 
devitalization  method,  284 
Purgatives,  29,  196 
Putrescent  pulps,  298 

treatment  of,  300 

in  deciduous  teeth,  320 
Pyorrhea  alveolaris,  339 

description  of  classes,  I,  339 
of  class  II,  340 
of  class  III,  341 

treatment  of  class  I,  343 
of  class  II,  3 50 
of  class  III,  355 
Pyrozone,  caustic,  85 

QUICKSILVER,  183 
Quinin,  139 
salts  of,  139 

DADIUM,  236 

*^      Rectum,  administration  by,  24 
Reduced  iron,  174 
Reducing  agents,  87 
Refrigerant  counterirritant,  prescrip- 
tion for,  297 
Remedies,  definition  of,  2 

hygienic,  2 

imponderable,  2 

mechanical,  2 

prophylactic,  2 


Remedies,  specific,  2 
Removing  the  pulp,  275 

in  deciduous  teeth,  291 
Resins,  5,  13,  14 
Resolution,  definition  of,  3 
Resorbed  root,  315 
Resorcin,  55 

Respiratory  stimulants,  165 
Restorative  stimulants,  169 
Restoratives,  32,  171 
Retainers  for  loose  teeth,   354,   356, 

357 
Rhatany,  70 
Rhigolene  spray,  120 
Rhizome,  6 
Rochelle  salt,  207 
Rontgen  ray,  235 
Root,  6 

Root-canal  fillings,  324 
Rose,  230 

SACCHARIN,  231 

0     Salol,  43 

Salophen,  44 

Saltpeter,  215 

Salt  solutions,  action  of,  204 

Sarsaparilla,  191 

Sassafras,  115,  227 

Schreier's  paste,  98 

for  putrescent  pulps,  303 
Scopola,  151 
Scopolamin,  1  52 
Secondary  dentin,  290 
Sedatives,  32 
Seed,  7 

Seidlitz  powder,  207 
Senna,  200 

Sensitive  dentin,  treatment  of,  261 
Sepals,  7 
Septic  pulps,  302 
Sialogogues,  32,  223 
Silver,  80 

nitrate,  81 

vitellin,  82 
Slippery  elm,  115 
Soap,  37 
Soapstone,  117 
Sodium  and  potassium,  97 
tartrate,  207 

bicarbonate,  35 

borate,  36 

bromid,  145 

dioxid,  83,  330 

hydroxid,  98 

treatment  of  poisoning  by,  99 

phosphate,  206 

salicylate,  45 

sulphate,  206 
Solutions,  8 

of  ammonium  acetate,  218 
Somnifacients,  31,  140 
Spearmint,  226 
Specific  disease,  2 

remedy,  2 
Spirits,  9 

of  mindererus,  218 

of  niter,  sweet,  218 


IN IM.X. 


383 


Spirit    of  nitn  (glycerin,  1  65 
of  nitrous  ether,  2  18 

"'.  354,  356-  357 
Squill, 
Stamens,  7 
Starch,  1 10 
Stem,  6 

Sterilization  of  instruments,  375 
Stigma,  7 

Stimulants,  $$,  i  54 
Stipes,  6 
Stomatitis,  mercurial,  183,  371 

gonorrheal,  373 
Strychnin,  1  54 

poisoning  and  treatment,  155 
Style,  7 

Styptics,  33,  67 
Sublamin,  189 
Suction,  237 
Sudorifics,  30 
Sugar  and  sugar  of  milk,  231 

of  lead,  7  5 
Suggestion,  238 
Sulphonal,  142 
Sulphur,  202 
Suppositories,  17 
Suprarenal  extract,  73 
Supra renalin,  73 
Sweet  oil,  in 

Sylvester's  method  of  artificial  respi- 
ration, 124 
Syphilis,  2,  184,  367 

primary,  367 

secondary,  185,  368 

tertiary,  182,  370 
Syrups,  9 

•TABLETS,  16 
A      Talc,  1 17 
Tamarind,  197 
Tannin,  68 
Tartar  emetic,  221 

Technic  of  applying  arsenical  prepa- 
rations, 286 

of  capping  pulps,  272 

of  injecting  local  anesthetics,  22 
Tepid  water,  as  an  emetic,  221 
Terebene,  104 
Therapeutic  effect,  2 
Therapeutics,  definition  of,  1 

empirical,  1 

rational,  1 
Thermometric  scale,  233 
Thymocamphen,  51 


74 


Thymol,  51 

iodid 
Thymophen,  51 

Thyroid  extract,  74 
Tinctures,  12 

Tobacco,  153 

Tolerance,  25 

Tonics,  32,   171 

Tooth  pi  m  der  .  2  53 

Toxicology,  definition  of,  3 

Tragacanth,  113 

Tricresol,  61 

Trional,  143 

Troches,  1  5 

Tropococain  hydrochlorid,  128 

Troy  weight,  240 

Tuber,  6 

Tuberculosis  of  the  mouth,  371 

Tully's  powder,  148 

Turpentine,  103 

I  JLMUS,  115 

^      Urotropin,  64 

VALERIAN,  170 
"       Vallet's  mass,  1 
Vanilla,  229 
Vaselin,  112 

liquid,  112 
Vinegars,  12 
Volatile  oils,  5 

group  of,  as  antiseptics,  45 

VyATERS,  8 
**       White  arsenic,  94 
White  vitriol,  76 
Witch-hazel,  7  1 
Wild  cherry,  168 
Wine  measure,  240 
Wines,  12 
Wood,  7 
Wool  fat,  112 

V-RAY,  225 
VELLOW  jasmine,  169 

7 INC  chlorid,  78 

^         iodid,  78 
oxid,  78 
phenolsulphonate,  77 
sulphocarbolate,  77 
sulphate,  76 


COLUMBIA  UNIVERSITY  LIBRARIES  Ihsl  stx) 

RK701B85  1910  C  1 

Modern  denial  materia  medica 


2002449560 


